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Organization
VILLAGE DRUG STORE
Active
Organization
VILLAGE DRUG STORE
Active
Other names
VILLAGE DRUG STORE INC
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH FRANK PETRICEK RPH (MANAGER)
(765) 364-0324
Entity
Organization
Contact information
Practice address
1313 HOMEWOOD DR, CRAWFORDSVILLE, IN 47933-3341
(765) 364-0324
(765) 364-0325
Mailing address
PO BOX 661, CRAWFORDSVILLE, IN 47933-0661
(765) 364-0324
(765) 364-0325
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
60002857A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100294590A
—
IN
01
—
1520887
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/11/2007
Last updated
10/26/2011
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