MEDICARE: THE APOTHECARY CENTER 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	3336C0004X	Compounding Pharmacy	3310	MA
2	3336C0003X	Community/Retail Pharmacy	3310	MA

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	:	1780741819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE APOTHECARY CENTER INC.

Provider Business Mailing Address
First Line	:	1985 MAIN ST
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01103-1095
Country	:	US
Telephone Number	:	413-734-2080
Fax Number	:	413-734-0374

Provider Business Practice Location Address
First Line	:	1985 MAIN ST
Second Line	:	SUITE J
City	:	SPRINGFIELD
State	:	MA
Zip	:	01103-1095
Country	:	US
Telephone Number	:	413-734-2080
Fax Number	:	413-734-0374

Authorized Official
Title or Position	:	TREASURER,OWNER
Name	:	MR. MARCEL ARTHUR NUNES
Credential	:	R.PH.
Telephone Number	:	413-734-2080

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	06/12/2012

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