Provider Demographics
NPI:1366473209
Name:VILAS LONG TERM CARE PHARMACY
Entity Type:Organization
Organization Name:VILAS LONG TERM CARE PHARMACY
Other - Org Name:COMMUNITY PHARMACIES, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-224-4538
Mailing Address - Street 1:PO BOX 1215
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-1215
Mailing Address - Country:US
Mailing Address - Phone:605-224-0907
Mailing Address - Fax:605-224-8027
Practice Address - Street 1:220 EAST DAKOTA AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501
Practice Address - Country:US
Practice Address - Phone:605-224-0907
Practice Address - Fax:605-224-8027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD200-16853336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy