Provider Demographics
NPI:1376641936
Name:RMAC VILLAGE PHARMACY DBA VILLAGE PHARMACY
Entity Type:Organization
Organization Name:RMAC VILLAGE PHARMACY DBA VILLAGE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:936-756-7456
Mailing Address - Street 1:1336 LEAGUE LINE RD
Mailing Address - Street 2:100
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3423
Mailing Address - Country:US
Mailing Address - Phone:936-756-7456
Mailing Address - Fax:936-701-5078
Practice Address - Street 1:1336 LEAGUE LINE RD
Practice Address - Street 2:100
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3423
Practice Address - Country:US
Practice Address - Phone:936-756-7456
Practice Address - Fax:936-701-5078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165613402Medicaid
TX165613401Medicaid
TX143795Medicaid
TX4569971OtherNCPDP