MEDICARE: APOTHECARY ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3336L0003X	Long Term Care Pharmacy
2	3336C0004X	Compounding Pharmacy
3	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
2	28-8578	OTHER	OK	OKLAHOMA STATE BOARD OF PHARMACY
3	71705	OTHER	OK	OKLAHOMA BUREAU OF NARCOTICS AND DANGEROUS DRUGS

General Provider Information

NPI Number	:	1396381679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APOTHECARY ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	PO BOX 2090
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096-8090
Country	:	US
Telephone Number	:	580-302-6500
Fax Number	:	580-302-6501

Provider Business Practice Location Address
First Line	:	1315 N WASHINGTON ST STE 3
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096-2443
Country	:	US
Telephone Number	:	580-302-6500
Fax Number	:	580-302-6501

Authorized Official
Title or Position	:	PHARMACY OWNER/MANAGER
Name	:	JOHNA K. ROOF
Credential	:	D.PH.
Telephone Number	:	580-302-6500

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	01/31/2020

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Directions to “APOTHECARY ASSOCIATES LLC ” Practice Location

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