# VILLAGE DRUG STORE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** VILLAGE DRUG STORE INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497805717
- **Authorized official:** JOSEPH FRANK PETRICEK RPH (MANAGER)
- **Authorized official phone:** (765) 364-0324

## Contact information

- **Practice address:** 1313 HOMEWOOD DR, CRAWFORDSVILLE, IN 47933-3341
- **Practice address phone:** (765) 364-0324
- **Practice address fax:** (765) 364-0325
- **Mailing address:** PO BOX 661, CRAWFORDSVILLE, IN 47933-0661
- **Mailing address phone:** (765) 364-0324
- **Mailing address fax:** (765) 364-0325

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 60002857A | IN | Yes |

## Other

- **Enumeration date:** 01/11/2007
- **Last updated:** 10/26/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100294590A | — | IN |
| 01 | — | 1520887 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |