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General NPI Number Information
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NPI Number | 1447255187
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Entity Type | Organization
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Legal Business Name | APOTHECARY SHOP OF MESA INC
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1432 S DOBSON RD STE 101
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City | MESA
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State | AZ
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Zip | 85202-4769
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Country | US
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Telephone | 480-969-9595
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Fax | 480-969-9494
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Provider Business Mailing Address
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Address Line | 23620 N 20TH DR STE 12
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City | PHOENIX
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State | AZ
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Zip | 85085-0621
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Country | US
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Telephone | 623-434-3650
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Fax | 623-434-3676
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Authorized Official
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Title or Position | CEO
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Name | JOHN MUSIL
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Credential | PHARMD
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Telephone | 623-434-3650
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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 | 4155
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License Number State | AZ
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