Healthcare Provider Details

I. General information

NPI: 1235114208
Provider Name (Legal Business Name): VILLAGE APOTHECARY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EAST ST
TEXARKANA AR
71854-6304
US

IV. Provider business mailing address

100 EAST ST
TEXARKANA AR
71854-6304
US

V. Phone/Fax

Practice location:
  • Phone: 870-772-6969
  • Fax: 870-774-0912
Mailing address:
  • Phone: 870-772-6969
  • Fax: 870-774-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberAR00363
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BUTLER
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 501-922-0777