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
—
—
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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