Healthcare Provider Details

I. General information

NPI: 1972487007
Provider Name (Legal Business Name): VILLAGE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 NE 62ND TER
LADY LAKE FL
32162-8622
US

IV. Provider business mailing address

504 FOXDALE RIDGE DR
CARY NC
27519-0808
US

V. Phone/Fax

Practice location:
  • Phone: 919-961-0715
  • Fax:
Mailing address:
  • Phone: 919-961-0715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. CHIOMA UCHECHI UGWA
Title or Position: OWNER
Credential:
Phone: 919-961-0715