Healthcare Provider Details

I. General information

NPI: 1467419606
Provider Name (Legal Business Name): APOTHECARY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1089 N COLLIER BLVD SUITE 409
MARCO ISLAND FL
34145-2563
US

IV. Provider business mailing address

1089 N COLLIER BLVD SUITE 409
MARCO ISLAND FL
34145-2563
US

V. Phone/Fax

Practice location:
  • Phone: 239-394-3111
  • Fax: 239-394-8841
Mailing address:
  • Phone: 239-394-3111
  • Fax: 239-394-8841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHA722
License Number StateFL

VIII. Authorized Official

Name: MR. LARRY G HEINE
Title or Position: OWNER
Credential: RPH
Phone: 239-394-3111