Healthcare Provider Details

I. General information

NPI: 1790076651
Provider Name (Legal Business Name): APOTHACA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 COVENTRY SHOPPERS PARK
COVENTRY RI
02816-5702
US

IV. Provider business mailing address

17 COVENTRY SHOPPERS PARK
COVENTRY RI
02816-5702
US

V. Phone/Fax

Practice location:
  • Phone: 401-481-3001
  • Fax: 401-633-6566
Mailing address:
  • Phone: 401-481-3001
  • Fax: 401-633-6566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DAVID C HUGHES
Title or Position: PRESIDENT AND CEO
Credential: PHARM.D.
Phone: 401-481-3001