Provider Demographics
NPI:1407933377
Name:ACV COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:ACV COMMUNITY SERVICES LLC
Other - Org Name:THE VILLAGE PHARMACY AT DOWLING PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-658-5500
Mailing Address - Street 1:PO BOX 4675
Mailing Address - Street 2:
Mailing Address - City:DOWLING PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-1507
Mailing Address - Country:US
Mailing Address - Phone:386-658-5860
Mailing Address - Fax:386-658-5864
Practice Address - Street 1:10820 MARVIN JONES BLVD
Practice Address - Street 2:
Practice Address - City:DOWLING PARK
Practice Address - State:FL
Practice Address - Zip Code:32060
Practice Address - Country:US
Practice Address - Phone:386-658-5860
Practice Address - Fax:386-658-5864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH223093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031816700Medicaid
2007855OtherPK