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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