Provider Demographics
NPI:1093720617
Name:VILLAGE APOTHECARY INC
Entity Type:Organization
Organization Name:VILLAGE APOTHECARY INC
Other - Org Name:VILLAGE HEALTHMART DRUG #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-620-4053
Mailing Address - Street 1:4440 N HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909-9301
Mailing Address - Country:US
Mailing Address - Phone:501-922-0777
Mailing Address - Fax:801-716-4872
Practice Address - Street 1:4440 N HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-9301
Practice Address - Country:US
Practice Address - Phone:501-922-0777
Practice Address - Fax:501-922-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 333600000X, 3336C0004X
ARAR069733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100590407Medicaid
1993603OtherPK
AR100590407Medicaid