Provider Demographics
NPI:1083721823
Name:VILLAGE PHARMACY OF WHITE PIGEON INC,
Entity Type:Organization
Organization Name:VILLAGE PHARMACY OF WHITE PIGEON INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GIERA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:269-483-7626
Mailing Address - Street 1:601 E CHICAGO RD
Mailing Address - Street 2:PO BOX 595
Mailing Address - City:WHITE PIGEON
Mailing Address - State:MI
Mailing Address - Zip Code:49099-9731
Mailing Address - Country:US
Mailing Address - Phone:269-483-7626
Mailing Address - Fax:269-483-9062
Practice Address - Street 1:601 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:WHITE PIGEON
Practice Address - State:MI
Practice Address - Zip Code:49099-9731
Practice Address - Country:US
Practice Address - Phone:269-483-7626
Practice Address - Fax:269-483-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010039833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1563049Medicaid
MI5302570001Medicare NSC