MEDICARE: ATLANTIC APOTHECARY INC.

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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1205494184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC APOTHECARY INC.

Provider Business Mailing Address
First Line	:	3816 HIGHWAY 17 S STE 2
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-5069
Country	:	US
Telephone Number	:	843-272-7900
Fax Number	:	843-272-5090

Provider Business Practice Location Address
First Line	:	3816 HIGHWAY 17 S STE 2
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-5069
Country	:	US
Telephone Number	:	843-272-7900
Fax Number	:	843-272-5090

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MRS. TERESA COX SHELLEY
Credential	:	RPH
Telephone Number	:	843-272-7900

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	06/05/2019

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