Organization
REESEVILLE VILLAGE PHARMACY LLC
Active
Other names
Village HealthMart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES LEE DYKSTRA R.PH, (SOLE MEMBER LLC)
(920) 927-3305
Entity
Organization
Contact information
Practice address
202 S. MAIN ST., REESEVILLE, WI 53579-0087
(920) 927-3305
(920) 927-3307
Mailing address
202 S. MAIN ST., P.O. BOX 87, REESEVILLE, WI 53579-0087
(920) 927-3305
(920) 927-3307
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
5761-042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33098800
—
WI
01
—
5109005
NCPDP NUMBER
WI
Enumeration date
11/13/2006
Last updated
02/05/2013
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