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Organization
VILLAGE APOTHECARY AT WILLIAMSBURG
Active
Organization
VILLAGE APOTHECARY AT WILLIAMSBURG
Active
Other names
Village Apothecary at Williamsburg
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH PETRICEK BSPH (PHARMACIST IN CHARGE)
(765) 364-0363
Entity
Organization
Contact information
Practice address
1609 LAFAYETTE RD RM 23, CRAWFORDSVILLE, IN 47933-1032
(765) 364-0363
(765) 362-2436
Mailing address
1609 LAFAYETTE RD RM 23, CRAWFORDSVILLE, IN 47933-1032
(765) 364-0363
(765) 362-2436
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
332BN1400X
Nursing Facility Supplies (DME)
—
NULL
332BX2000X
Oxygen Equipment & Supplies (DME)
—
NULL
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
60006523A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201348390A
—
IN
01
—
2155103
PK
—
Enumeration date
11/05/2015
Last updated
09/30/2016
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