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General NPI Number Information
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NPI Number | 1215396346
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Entity Type | Organization
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Legal Business Name | VILLA PHARMACY LLC
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 105 AVENUE R NW
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City | WINTER HAVEN
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State | FL
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Zip | 33881-2147
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Country | US
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Telephone | 863-229-5978
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Fax | 863-662-3953
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Provider Business Mailing Address
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Address Line | 105 AVENUE R NW
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City | WINTER HAVEN
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State | FL
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Zip | 33881-2147
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Country | US
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Telephone | 863-229-5978
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Fax | 863-662-3953
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. DWAYNE JONES
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Credential |
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Telephone | 863-229-5978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH2986
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License Number State | FL
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