Organization
APOTHECARY SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES WILLIAMS (PHARMACIST OWNER)
(863) 676-1174
Entity
Organization
Contact information
Practice address
437 S 11TH ST, LAKE WALES, FL 33853-4250
(863) 676-1174
(863) 676-5830
Mailing address
437 S 11TH ST, LAKE WALES, FL 33853-4250
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PH006754
FL
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013553
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
P3131
BCBS OF FLORIDA
FL
Enumeration date
07/30/2006
Last updated
03/26/2008
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