Boothwyn Apothecary, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP482258 Issued in PA

Legal business name

BOOTHWYN APOTHECARY, LLC

Practice address

2341 Chichester Ave
Upper Chichester, PA 19061-3737

Phone

(610) 485-1130

Fax

(610) 485-9223

NPI assigned

Dec 11, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Louis Micolucci, RPH

Title

Ceo & Manager

Phone

(610) 485-1130

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Tax ID family

Boothwyn Apothecary LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Boothwyn Apothecary, LLC

  • Long Term Care Pharmacy
  • Upper Chichester, PA
  • NPI 1134720352
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597881600000",
    "number": "1649601998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2341 CHICHESTER AVE",
            "city": "UPPER CHICHESTER",
            "state": "PA",
            "postal_code": "190613737",
            "telephone_number": "610-485-1130",
            "fax_number": "610-485-9223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2341 CHICHESTER AVE",
            "city": "UPPER CHICHESTER",
            "state": "PA",
            "postal_code": "190613737",
            "telephone_number": "610-485-1130",
            "fax_number": "610-485-9223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOOTHWYN APOTHECARY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-11",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A",
        "authorized_official_last_name": "MICOLUCCI",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_title_or_position": "CEO & MANAGER",
        "authorized_official_telephone_number": "610-485-1130",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP482258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tarlan Arshian, DMD
• Lylelaine Bacalla
• Balance Prosthetics and Orthotics Inc
• Noel Boehm
• Boothwyn Apothecary, LLC
• Maryn R Brutus, OTD, OTR/L
• Racheal Bundor, CEO
• Matthew Burrichter, PHARMD
• Katie Cao
• Alisa Cheriachangel, OD

• Community/Retail Pharmacy in Upper Chichester, PA
• Providers in Upper Chichester, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.