Organization
VILLAGE APOTHECARY AT WILLIAMSBURG
Active
Other names
Village Apothecary at Williamsburg
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH PETRICEK BSPH (PHARMACIST IN CHARGE)
(765) 364-0363
Entity
Organization
Contact information
Practice address
1609 LAFAYETTE RD RM 23, CRAWFORDSVILLE, IN 47933-1032
(765) 364-0363
(765) 362-2436
Mailing address
1609 LAFAYETTE RD RM 23, CRAWFORDSVILLE, IN 47933-1032
(765) 364-0363
(765) 362-2436
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
60006523A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201348390A
—
IN
01
—
2155103
PK
—
Enumeration date
11/05/2015
Last updated
09/30/2016
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