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General NPI Number Information
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NPI Number | 1174006399
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Entity Type | Organization
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Legal Business Name | VILLAGE DISCOUNT PHARMACY
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 3990 E ST 44 SUITE 207 E SR44 SUITE 207
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City | WILDWOOD
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State | FL
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Zip | 34785
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Country | US
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Telephone | 407-492-3041
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Fax | 352-399-6234
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Provider Business Mailing Address
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Address Line | 3990 E SR 44 STE 207
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City | WILDWOOD
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State | FL
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Zip | 34785-7482
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Country | US
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Telephone | 352-492-9333
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Fax | 352-399-6234
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Authorized Official
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Title or Position | OWNER /PIC
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Name | MR. GAMAL ABOUELWAFA OMAR
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Credential | RPH
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Telephone | 352-492-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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