Organization
APOTHECARY SHOP OF LOS ANGELES INC
Active
Parent organization
APOTHECARY HOLDINGS INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
APOTHECARY HOLDINGS INC
Authorized official
JOHN D MUSIL PHARMD, RPH (DIRECTOR/CEO)
(623) 434-3657
Entity
Organization
Contact information
Practice address
325 N LARCHMONT BLVD, LOS ANGELES, CA 90004-3011
(323) 466-1414
(323) 466-1333
Mailing address
1606 W WHISPERING WIND DR, PHOENIX, AZ 85085-0678
(623) 434-3659
(623) 434-3673
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY 49836
CA
3336C0004X
Compounding Pharmacy
PHY 49836
CA
3336S0011X
Specialty Pharmacy
PHY 49836
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0519263
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
CN874A
MEDICARE PART B MASS IMMUNIZATION ROSTER BILLER
—
05
—
PHA165980
—
CA
Enumeration date
11/08/2006
Last updated
03/23/2010
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