Organization
MODERN APOTHECARY, LLC
Active
Other names
Modern Apothecary
Organization subpart
No
Provider details
NPI number
Authorized official
ERIN E MERRITT PHARMD (OWNER)
(262) 997-9573
Entity
Organization
Contact information
Practice address
5700 6TH AVE, KENOSHA, WI 53140-4104
(262) 997-9573
(262) 997-9574
Mailing address
5700 6TH AVE, KENOSHA, WI 53140-4104
(262) 997-9573
(262) 997-9574
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
9274-42
WI
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5134476
NCPDP NUMBER
—
Enumeration date
08/04/2014
Last updated
01/31/2024
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