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General NPI Number Information
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NPI Number | 1003898545
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Entity Type | Organization
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Legal Business Name | APOTHECARY SHOPPE, INC
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 12/27/2010
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Provider Practice Location Address
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Address Line | 82 S 1100 E SUITE 104
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1686
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Country | US
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Telephone | 801-521-6353
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Fax | 801-521-6390
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Provider Business Mailing Address
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Address Line | 82 S 1100 E SUITE 104
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1686
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Country | US
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Telephone | 801-521-6353
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Fax | 801-521-6390
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEVIN LEE DEMASS
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Credential | R.PH.
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Telephone | 801-521-6353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 6895933-1703
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License Number State | UT
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