MEDICARE: APOTHECARY ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist
2	332B00000X	Durable Medical Equipment & Medical Supplies	2279	TN
3	3336L0003X	Long Term Care Pharmacy	2279	TN
4	3336C0003X	Community/Retail Pharmacy	2279	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4420357	OTHER	TN	NCPDP #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528033842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APOTHECARY ASSOCIATES INC

Provider Business Mailing Address
First Line	:	1500 MADISON ST.
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040
Country	:	US
Telephone Number	:	931-552-2552
Fax Number	:	931-551-8198

Provider Business Practice Location Address
First Line	:	1500 MADISON ST.
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040
Country	:	US
Telephone Number	:	931-552-2552
Fax Number	:	931-551-8198

Authorized Official
Title or Position	:	PIC/OWNER
Name	:	KATINA RENEA SYKES
Credential	:
Telephone Number	:	931-552-2552

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	10/16/2019

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