Healthcare Provider Details

I. General information

NPI: 1487747655
Provider Name (Legal Business Name): APOTHECARE OF PLYMOUTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CAMELOT DR STE 3
PLYMOUTH MA
02360-3037
US

IV. Provider business mailing address

121 CAMELOT DR STE 3
PLYMOUTH MA
02360-3037
US

V. Phone/Fax

Practice location:
  • Phone: 508-732-9700
  • Fax: 508-732-9788
Mailing address:
  • Phone: 508-732-9700
  • Fax: 508-732-9788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number3481
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number3481
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3481
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number3481
License Number StateMA

VIII. Authorized Official

Name: SUSAN NELSON
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 508-732-9700