MEDICARE: APOTHACARY 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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1275344210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APOTHACARY INC

Provider Business Mailing Address
First Line	:	2811 W MARKET ST STE 5
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-5127
Country	:	US
Telephone Number	:	423-928-8004
Fax Number	:	423-928-8008

Provider Business Practice Location Address
First Line	:	2811 W MARKET ST STE 5
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-5127
Country	:	US
Telephone Number	:	423-928-8004
Fax Number	:	423-928-8008

Authorized Official
Title or Position	:	MEMBER
Name	:	AHMED ATYIA
Credential	:
Telephone Number	:	423-928-8004

Provider Enumeration Date	:	01/17/2025
Last Update Date	:	01/17/2025

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