Healthcare Provider Details

I. General information

NPI: 1548806870
Provider Name (Legal Business Name): VILLAGE RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 04/05/2020
Certification Date: 04/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 DONELSON AVE
OLD HICKORY TN
37138-3113
US

IV. Provider business mailing address

1100 DONELSON AVE
OLD HICKORY TN
37138-3113
US

V. Phone/Fax

Practice location:
  • Phone: 615-541-7374
  • Fax: 615-357-0046
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
IdentifierQ056227
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name: THOMAS T HEILMAN
Title or Position: PHARMACIST/OWNER
Credential: PHARM-D
Phone: 615-574-3766