# OLD TOWN APOTHECARY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013431675
- **Authorized official:** CAMEON SCHULTE PHARM.D. (MEMBER)
- **Authorized official phone:** (573) 634-8300

## Contact information

- **Practice address:** 1739 ELM CT STE 108, JEFFERSON CITY, MO 65101-4303
- **Practice address phone:** (573) 634-8300
- **Mailing address:** 1739 ELM CT STE 108, JEFFERSON CITY, MO 65101-4303

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | — | Yes |

## Other

- **Enumeration date:** 07/26/2017
- **Last updated:** 07/26/2017