Provider Demographics
NPI:1295966414
Name:APOTHECARY POINTE PHARMACY INC
Entity type:Organization
Organization Name:APOTHECARY POINTE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:HYMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:801-825-6400
Mailing Address - Street 1:3443 W 5600 S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-9103
Mailing Address - Country:US
Mailing Address - Phone:801-825-6400
Mailing Address - Fax:801-825-6449
Practice Address - Street 1:3443 W 5600 S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-9103
Practice Address - Country:US
Practice Address - Phone:801-825-6400
Practice Address - Fax:801-825-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
UT901085917033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2121499OtherPK
UT=========001Medicaid