Healthcare Provider Details

I. General information

NPI: 1770514234
Provider Name (Legal Business Name): VILAS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAC LN SUITE #2
PIERRE SD
57501-3391
US

IV. Provider business mailing address

100 MAC LN SUITE #2
PIERRE SD
57501-3391
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-7334
  • Fax: 605-945-4292
Mailing address:
  • Phone: 605-224-7334
  • Fax: 605-945-4292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number100-0970
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number100-0970
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JAMES R. STEPHENS
Title or Position: PRESIDENT
Credential:
Phone: 605-224-7334