Provider Demographics
NPI:1548489396
Name:CLINICAL APOTHECARIES, INC.
Entity type:Organization
Organization Name:CLINICAL APOTHECARIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:330-721-7949
Mailing Address - Street 1:4087 MEDINA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5946
Mailing Address - Country:US
Mailing Address - Phone:330-721-7949
Mailing Address - Fax:330-721-9420
Practice Address - Street 1:4087 MEDINA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5946
Practice Address - Country:US
Practice Address - Phone:330-721-7949
Practice Address - Fax:330-721-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-11467503336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3667598OtherNABP#
OH3667598OtherNABP#