Organization
VILLIAGE PHARMACY INC
Active
Other names
VILLAGE PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
CASEY PERRY (MANAGER)
(662) 873-9020
Entity
Organization
Contact information
Practice address
48 S FOURTH ST, ROLLING FORK, MS 39159-5147
(662) 873-9020
(662) 873-9080
Mailing address
48 S FOURTH ST, ROLLING FORK, MS 39159-5147
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
03144/01.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330208
—
MS
01
—
2518465
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/12/2005
Last updated
11/20/2009
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