Provider Demographics
NPI:1861565665
Name:APOTHECO PHARMACY DECATUR LLC
Entity type:Organization
Organization Name:APOTHECO PHARMACY DECATUR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-869-2820
Mailing Address - Street 1:788 MORRIS TPKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078
Mailing Address - Country:US
Mailing Address - Phone:973-869-2820
Mailing Address - Fax:973-369-2822
Practice Address - Street 1:17680 KEDZIE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429
Practice Address - Country:US
Practice Address - Phone:708-957-4949
Practice Address - Fax:708-957-4968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364403357001Medicaid
IL=========Medicaid
IL1459052OtherNABP NUMBER