Basic Information
| Provider Information | |||||||||
| NPI: | 1255065959 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PINNACLE APOTHECARY, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PINNACLE APOTHECARY CANDLER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 81 HARRELL DR | ||||||||
| Address2: | |||||||||
| City: | LAKE JUNALUSKA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287459758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034296922 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1388 SAND HILL RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | CANDLER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287158937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287616244 | ||||||||
| FaxNumber: | 8287616245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2022 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SNIPES | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8282206411 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PINNACLE APOTHECARY, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PHARMD | ||||||||
| NPICertificationDate: | 08/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.