=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174922926
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APOTHECARXY SPECIALTY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2014
-----------------------------------------------------
Last Update Date | 09/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5214 98TH ST STE 303
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79424-4493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-368-8317
-----------------------------------------------------
Fax | 806-368-8736
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5214 98TH STREET, STE 303
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-368-8317
-----------------------------------------------------
Fax | 806-368-8736
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHARMACIST
-----------------------------------------------------
Name | MINDY SEXTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 806-470-8389
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 29454
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------