=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245055417
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APOTHECO PHARMACY PROVIDENCE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2024
-----------------------------------------------------
Last Update Date | 02/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 66 BRANCH AVE
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02904-2756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-414-4147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 788 MORRIS TPKE STE 300
-----------------------------------------------------
City | SHORT HILLS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07078-2634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-869-2820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & OFFICER
-----------------------------------------------------
Name | MR. ANUSH AMIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-869-2820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------