# APOTHEKE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** THE VINTAGE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669577425
- **Authorized official:** KIMBERLY ICKES RPH (OWNER)
- **Authorized official phone:** (440) 963-7760

## Contact information

- **Practice address:** 1605 STATE ROUTE 60, SUITE 11, VERMILION, OH 44089
- **Practice address phone:** (440) 967-3100
- **Practice address fax:** (440) 967-3110
- **Mailing address:** 1605 STATE ROUTE 60, SUITE 11, VERMILION, OH 44089
- **Mailing address phone:** (440) 967-3100
- **Mailing address fax:** (440) 967-3110

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 021800200 | OH | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 10/05/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0624677 | — | OH |
| 01 | — | 3644956 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |