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General NPI Number Information
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NPI Number | 1063729101
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Entity Type | Organization
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Legal Business Name | APOTHECA LLC
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 129 W. COLORADO AVENUE
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City | TELLURIDE
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State | CO
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Zip | 81435
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Country | US
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Telephone | 970-728-0488
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Fax | 970-728-0487
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Provider Business Mailing Address
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Address Line | PO BOX 3270
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City | TELLURIDE
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State | CO
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Zip | 81435-3270
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Country | US
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Telephone | 970-728-0488
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Fax | 970-728-0487
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Authorized Official
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Title or Position | MANAGING MMBR/OWNER/PHARM MGR
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Name | MICHELLE COMMON
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Credential |
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Telephone | 970-708-9982
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PDO0000000805
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License Number State | CO
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