Healthcare Provider Details

I. General information

NPI: 1962457796
Provider Name (Legal Business Name): VILLAGE PHARMACY OF NOKOMIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 TAMIAMI TRL N STE B
NOKOMIS FL
34275-2114
US

IV. Provider business mailing address

1095 TAMIAMI TRL N STE B
NOKOMIS FL
34275-2114
US

V. Phone/Fax

Practice location:
  • Phone: 941-488-8800
  • Fax: 941-488-8802
Mailing address:
  • Phone: 941-488-8800
  • Fax: 941-488-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH21919
License Number StateFL

VIII. Authorized Official

Name: JEFFREY YOUNG
Title or Position: MGR
Credential: R.PH.
Phone: 941-488-8800