Apotheke Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

021800200 Issued in OH

Legal business name

APOTHEKE INC

Doing business as

The Vintage Pharmacy

Practice address

1605 State Route 60
Suite 11
Vermilion, OH 44089

Phone

(440) 967-3100

Fax

(440) 967-3110

NPI assigned

Sep 14, 2006

Last updated

Oct 5, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly Ickes, RPH

Title

Owner

Phone

(440) 963-7760

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• THE VINTAGE PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317772800000",
    "number": "1669577425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 STATE ROUTE 60",
            "address_2": "SUITE 11",
            "city": "VERMILION",
            "state": "OH",
            "postal_code": "44089",
            "telephone_number": "440-967-3100",
            "fax_number": "440-967-3110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 STATE ROUTE 60",
            "address_2": "SUITE 11",
            "city": "VERMILION",
            "state": "OH",
            "postal_code": "44089",
            "telephone_number": "440-967-3100",
            "fax_number": "440-967-3110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APOTHEKE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2011-10-05",
        "status": "A",
        "authorized_official_last_name": "ICKES",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "440-963-7760",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "021800200",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0624677",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3644956",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE VINTAGE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Vermilion, OH
• Providers in Vermilion, OH by specialty
• Community/Retail Pharmacy in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.