=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457622219
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2012
-----------------------------------------------------
Last Update Date | 01/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29811 WALKER SOUTH RD.
-----------------------------------------------------
City | WALKER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-698-0800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29811 WALKER SOUTH RD.
-----------------------------------------------------
City | WALKER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | MR. KIRK JEANE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-698-0800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------