Organization
APOTHEKE INC
Active
Other names
STADIUM PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY ICKES RPH (OWNER)
(440) 967-3100
Entity
Organization
Contact information
Practice address
2205 HAYES AVE, SANDUSKY, OH 44870-4705
(419) 626-1103
(419) 626-1244
Mailing address
2205 HAYES AVE, SANDUSKY, OH 44870-4705
(419) 626-1103
(419) 626-1244
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RTP021800250
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2075484
PK
—
05
—
3653148
—
OH
Enumeration date
08/10/2006
Last updated
12/12/2013
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