MEDICARE: VILLAGE APOTHECARY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	261357	MN

General Provider Information

NPI Number	:	1366657033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE APOTHECARY INC

Provider Business Mailing Address
First Line	:	PO BOX 538
Second Line	:
City	:	BATTLE LAKE
State	:	MN
Zip	:	56515-0538
Country	:	US
Telephone Number	:	218-864-5261
Fax Number	:	218-864-8178

Provider Business Practice Location Address
First Line	:	113 LAKE AVE NORTH
Second Line	:
City	:	BATTLE LAKE
State	:	MN
Zip	:	56515-0538
Country	:	US
Telephone Number	:	218-864-5261
Fax Number	:	218-864-8178

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAY OLSON
Credential	:
Telephone Number	:	218-864-5261

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/22/2020

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