Healthcare Provider Details

I. General information

NPI: 1770017832
Provider Name (Legal Business Name): APOTHECARY PHARMACY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2017
Last Update Date: 09/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E. LISA STE C
CHAPARRAL NM
88081
US

IV. Provider business mailing address

550 E LISA DR STE C
CHAPARRAL NM
88081-8080
US

V. Phone/Fax

Practice location:
  • Phone: 575-824-5242
  • Fax: 575-824-4066
Mailing address:
  • Phone: 575-824-5242
  • Fax: 575-824-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GAURAVKUMAR CHAUDHARI
Title or Position: PRESIDENT AND PHARMACIST IN CHARGE
Credential: PHARM.D
Phone: 575-824-5242