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General NPI Number Information
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NPI Number | 1982882429
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Entity Type | Organization
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Legal Business Name | APOTHECARY BOTANICA
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 417 MACE BLVD SUITE D
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City | DAVIS
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State | CA
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Zip | 95618-6053
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Country | US
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Telephone | 530-231-6520
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Fax | 530-231-6429
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Provider Business Mailing Address
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Address Line | 417 MACE BLVD SUITE D
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City | DAVIS
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State | CA
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Zip | 95618-6053
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Country | US
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Telephone | 530-231-6520
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Fax | 530-231-6429
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. BRADLEY JAY BRAZILL
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Credential | PHARM.D.
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Telephone | 530-231-6520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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