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General NPI Number Information
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NPI Number | 1780446161
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Entity Type | Organization
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Legal Business Name | VILLAGE PARK PHARMACY LLC
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Dates
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Enumeration Date | 01/30/2024
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 24420 FM 1314 RD STE 13
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City | PORTER
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State | TX
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Zip | 77365-5490
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Country | US
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Telephone | 281-747-7164
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Fax | 346-423-0107
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Provider Business Mailing Address
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Address Line | 24420 FM 1314 RD STE 13
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City | PORTER
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State | TX
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Zip | 77365-5490
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Country | US
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Telephone | 281-747-7164
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEMETRIA HOLMES
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Credential |
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Telephone | 832-793-2800
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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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