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General NPI Number Information
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NPI Number | 1083672059
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Entity Type | Organization
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Legal Business Name | MEDICAL VILLAGE PHARMACY, INC.
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 815 FAIRGROVE CHURCH RD
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City | CONOVER
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State | NC
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Zip | 28613-8609
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Country | US
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Telephone | 828-322-4505
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Fax | 828-322-2669
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Provider Business Mailing Address
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Address Line | 815 FAIRGROVE CHURCH RD
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City | CONOVER
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State | NC
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Zip | 28613-8609
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Country | US
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Telephone | 828-322-4505
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Fax | 828-322-2669
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RONALD JAMES SHOKES
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Credential | RPH
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Telephone | 828-322-4505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 3132
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License Number State | NC
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