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Organization
VILLAGE LANE APOTHECARY, L.L.C.
Active
Organization
VILLAGE LANE APOTHECARY, L.L.C.
Active
Other names
Village Lane Apothecary
Organization subpart
No
Provider details
NPI number
Authorized official
LESLI HOLT (PHARMACIST IN CHARGE)
(817) 717-2000
Entity
Organization
Contact information
Practice address
60 VILLAGE LN STE 130, COLLEYVILLE, TX 76034-2928
(817) 717-2000
(817) 717-8424
Mailing address
60 VILLAGE LN STE 130, COLLEYVILLE, TX 76034-2928
(817) 717-2000
(817) 717-8424
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
30288
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2154971
PK
—
Enumeration date
11/02/2015
Last updated
11/02/2015
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