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General NPI Number Information
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NPI Number | 1972054468
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Entity Type | Organization
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Legal Business Name | VILLAGE APOTHECARY, INC.
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 100 EAST ST
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City | TEXARKANA
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State | AR
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Zip | 71854
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Country | US
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Telephone | 870-772-6969
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Fax | 870-773-8657
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Provider Business Mailing Address
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Address Line | 100 EAST ST
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City | TEXARKANA
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State | AR
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Zip | 71854
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Country | US
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Telephone | 870-772-6969
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Fax | 870-773-8657
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL BUTLER
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Credential | PHARMD
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Telephone | 501-620-4053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | AR00363
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | AR00363
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | AR00363
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License Number State | AR
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