Provider Demographics
NPI:1235114208
Name:VILLAGE APOTHECARY, INC
Entity Type:Organization
Organization Name:VILLAGE APOTHECARY, INC
Other - Org Name:COLLEGE HILL DRUG
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:501-922-0777
Mailing Address - Street 1:100 EAST ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-6304
Mailing Address - Country:US
Mailing Address - Phone:870-772-6969
Mailing Address - Fax:870-774-0912
Practice Address - Street 1:100 EAST ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-6304
Practice Address - Country:US
Practice Address - Phone:870-772-6969
Practice Address - Fax:870-774-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR00363333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155396OtherPK
AR0905950001Medicare NSC
TX580007Medicaid