# VILLAGE APOTHECARY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** THE VILLAGE APOTHECARY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053459040
- **Authorized official:** RONALD GUSSICK RPH (PRESIDENT)
- **Authorized official phone:** (920) 533-4012

## Contact information

- **Practice address:** 110 W MAIN ST, CAMPBELLSPORT, WI 53010-2704
- **Practice address phone:** (920) 533-4012
- **Practice address fax:** (920) 533-4012
- **Mailing address:** 110 W MAIN ST, CAMPBELLSPORT, WI 53010-2704

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 5998042 | WI | Yes |

## Other

- **Enumeration date:** 02/02/2007
- **Last updated:** 09/12/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33008900 | — | WI |
| 01 | — | 5113636 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |