Healthcare Provider Details

I. General information

NPI: 1174693253
Provider Name (Legal Business Name): APOTHECARY SHOP OF LOS ANGELES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N LARCHMONT BLVD
LOS ANGELES CA
90004-3011
US

IV. Provider business mailing address

1606 W WHISPERING WIND DR
PHOENIX AZ
85085-0678
US

V. Phone/Fax

Practice location:
  • Phone: 323-466-1414
  • Fax: 323-466-1333
Mailing address:
  • Phone: 623-434-3659
  • Fax: 623-434-3673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 49836
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY 49836
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHY 49836
License Number StateCA

VIII. Authorized Official

Name: JOHN D MUSIL
Title or Position: DIRECTOR/CEO
Credential: PHARMD, RPH
Phone: 623-434-3657