Healthcare Provider Details
I. General information
NPI: 1093976094
Provider Name (Legal Business Name): VILLAGE APOTHECARY INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/23/2008
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4440 N HIGHWAY 7
HOT SPRINGS AR
71909-9301
US
IV. Provider business mailing address
4440 N HIGHWAY 7
HOT SPRINGS AR
71909-9301
US
V. Phone/Fax
- Phone: 501-922-0777
- Fax: 501-922-0787
- Phone: 501-922-0777
- Fax: 501-922-0787
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 332BP3500X |
| Taxonomy | Parenteral & Enteral Nutrition Supplies (DME) |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 332BX2000X |
| Taxonomy | Oxygen Equipment & Supplies (DME) |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
MICHAEL
D
BUTLER
Title or Position: OWNER
Credential: PHARMD
Phone: 501-922-0777