MEDICARE: THE APOTHECARY SHOPPE PHARMACIES, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	5301008204	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2334857	OTHER	MI	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	540B812050	OTHER	MI	BCBS DME

General Provider Information

NPI Number	:	1518047224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE APOTHECARY SHOPPE PHARMACIES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1727
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48641-1727
Country	:	US
Telephone Number	:	800-313-3677
Fax Number	:	989-631-2820

Provider Business Practice Location Address
First Line	:	1217 E FRONT ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-2928
Country	:	US
Telephone Number	:	231-947-9825
Fax Number	:	231-947-3102

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. GARY PACH
Credential	:
Telephone Number	:	800-313-3677

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/17/2009

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