=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578891669
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE APOTHECARY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2009
-----------------------------------------------------
Last Update Date | 05/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7305 NC HIGHWAY 22
-----------------------------------------------------
City | WHISPERING PINES
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28327-8512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-949-3700
-----------------------------------------------------
Fax | 910-949-3800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7305 NC HIGHWAY 22
-----------------------------------------------------
City | WHISPERING PINES
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28327-8512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-949-3700
-----------------------------------------------------
Fax | 910-949-3800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PHARMACIST
-----------------------------------------------------
Name | WALTER SPIVEY
-----------------------------------------------------
Credential | PHARM. D, R.PH.
-----------------------------------------------------
Telephone | 910-639-0209
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 10400
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------