Provider Demographics
NPI:1336137496
Name:VILLAGE PHARMACY INC
Entity Type:Organization
Organization Name:VILLAGE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEASAMER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-795-3130
Mailing Address - Street 1:PO BOX 1087
Mailing Address - Street 2:
Mailing Address - City:ROBERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27871-1087
Mailing Address - Country:US
Mailing Address - Phone:252-795-3130
Mailing Address - Fax:252-795-5511
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROBERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27871
Practice Address - Country:US
Practice Address - Phone:252-795-3130
Practice Address - Fax:252-795-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC03102332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0585067Medicaid
NC3413820OtherNABP
NC7700489OtherMEDICAID DME
NC3413820OtherNABP
NC7700489OtherMEDICAID DME