# VILLAGE APOTHECARY AT WILLIAMSBURG

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Village Apothecary at Williamsburg
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043683568
- **Authorized official:** JOSEPH PETRICEK BSPH (PHARMACIST IN CHARGE)
- **Authorized official phone:** (765) 364-0363

## Contact information

- **Practice address:** 1609 LAFAYETTE RD RM 23, CRAWFORDSVILLE, IN 47933-1032
- **Practice address phone:** (765) 364-0363
- **Practice address fax:** (765) 362-2436
- **Mailing address:** 1609 LAFAYETTE RD RM 23, CRAWFORDSVILLE, IN 47933-1032
- **Mailing address phone:** (765) 364-0363
- **Mailing address fax:** (765) 362-2436

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | 60006523A | IN | Yes |

## Other

- **Enumeration date:** 11/05/2015
- **Last updated:** 09/30/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 201348390A | — | IN |
| 01 | — | 2155103 | PK | — |