APOTHECARY SHOP OF PAYSON — NPI 1114922861 (Licensed & Credentialed Suppliers

CMS-1500 Box 24J / 33a • NPI

1114922861

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

333600000X (CMS 58)

Licensed & Credentialed Suppliers — Pharmacy

Box 32 Service Location & ZIP+4

201 W MAIN ST, STE L, PAYSON, AZ, 85541-5442

✓ 9-Digit EDI 837 ZIP+4 (85541-5442)

Practice Phone & Referral Fax

(928) 468-8299

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1114922861 (APOTHECARY SHOP OF PAYSON) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1114922861` (NPI-2 Organization / Facility)
Provider / Legal Name	APOTHECARY SHOP OF PAYSON
Plain-English Specialty	Licensed & Credentialed Suppliers — Pharmacy NUCC Code: `333600000X` (Pharmacy)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	201 W MAIN ST, STE L, PAYSON, AZ, 85541-5442
Practice Telephone / Fax	Tel: (928) 468-8299
Administrative Mailing Address	9777 N 91ST ST, SCOTTSDALE, AZ, 85258-5087
Enumeration & Last Sync	Enumerated: 2005-06-19 \| CMS Record Updated: 2020-08-22
Authorized Official	JOHN MUSIL (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

201 W MAIN ST, STE L, PAYSON, AZ, 85541-5442

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Plain-English Taxonomy & CMS Crosswalk (333600000X)

What Does Taxonomy Code 333600000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 333600000X translates to:
"Licensed & Credentialed Suppliers — Pharmacy"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 58 (Medical Supply Company with Pharmacist) • CMS Code A5 (Pharmacy)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Pharmacy for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (APOTHECARY SHOP OF PAYSON)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`333600000X` — Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy	State: AZ \| License: `YO3386` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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APOTHECARY SHOP OF PAYSON (NPI #1114922861)