Healthcare Provider Details

I. General information

NPI: 1972054468
Provider Name (Legal Business Name): VILLAGE APOTHECARY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EAST ST
TEXARKANA AR
71854
US

IV. Provider business mailing address

100 EAST ST
TEXARKANA AR
71854
US

V. Phone/Fax

Practice location:
  • Phone: 870-772-6969
  • Fax: 870-773-8657
Mailing address:
  • Phone: 870-772-6969
  • Fax: 870-773-8657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberAR00363
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberAR00363
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberAR00363
License Number StateAR

VIII. Authorized Official

Name: DR. MICHAEL BUTLER
Title or Position: OWNER
Credential: PHARMD
Phone: 501-620-4053