MEDICARE: BL APOTHECARY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104396258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BL APOTHECARY

Provider Business Mailing Address
First Line	:	229 S MAIN ST
Second Line	:
City	:	RED SPRINGS
State	:	NC
Zip	:	28377-1621
Country	:	US
Telephone Number	:	910-359-8009
Fax Number	:	910-227-2397

Provider Business Practice Location Address
First Line	:	229 S MAIN ST
Second Line	:
City	:	RED SPRINGS
State	:	NC
Zip	:	28377-1621
Country	:	US
Telephone Number	:	910-359-8009
Fax Number	:	910-227-2397

Authorized Official
Title or Position	:	OWNER/PIC
Name	:	DR. BRONSON LEE LOWERY
Credential	:	PHARMD
Telephone Number	:	910-359-8009

Provider Enumeration Date	:	12/03/2018
Last Update Date	:	12/31/2025

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