Healthcare Provider Details

I. General information

NPI: 1780741819
Provider Name (Legal Business Name): THE APOTHECARY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 MAIN ST SUITE J
SPRINGFIELD MA
01103-1095
US

IV. Provider business mailing address

1985 MAIN ST
SPRINGFIELD MA
01103-1095
US

V. Phone/Fax

Practice location:
  • Phone: 413-734-2080
  • Fax: 413-734-0374
Mailing address:
  • Phone: 413-734-2080
  • Fax: 413-734-0374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number3310
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3310
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0497410
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: MR. MARCEL ARTHUR NUNES
Title or Position: TREASURER,OWNER
Credential: R.PH.
Phone: 413-734-2080