Healthcare Provider Details

I. General information

NPI: 1841639960
Provider Name (Legal Business Name): VILLAGE APOTHECARY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 S GEORGE
MT IDA AR
71953
US

IV. Provider business mailing address

4440 N HIGHWAY 7
HOT SPRINGS AR
71909-9301
US

V. Phone/Fax

Practice location:
  • Phone: 870-867-0106
  • Fax: 870-867-0134
Mailing address:
  • Phone: 501-922-0777
  • Fax: 866-448-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberMG01169
License Number StateAR

VIII. Authorized Official

Name: DR. MICHAEL D. BUTLER
Title or Position: OWNER
Credential: PHARMD
Phone: 501-922-0777