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General NPI Number Information
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NPI Number | 1578050423
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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 | 04/17/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 171 N. CORA ST. SUITE 100
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City | RIDGWAY
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State | CO
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Zip | 81432
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Country | US
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Telephone | 970-626-4432
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Fax | 970-626-4032
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Provider Business Mailing Address
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Address Line | PO BOX 1299
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City | RIDGWAY
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State | CO
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Zip | 81432-1299
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Country | US
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Telephone | 970-626-4432
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Fax | 970-626-4032
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Authorized Official
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Title or Position | PIC, MANAGING MEMBER
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Name | MICHELLE COMMON
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Credential |
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Telephone | 970-728-0488
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | OO.0000611
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License Number State | CO
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