Provider Demographics
NPI:1467917039
Name:NORTH VILLAGE PHARMACY INC
Entity Type:Organization
Organization Name:NORTH VILLAGE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-694-4104
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:YANCEYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27379-1209
Mailing Address - Country:US
Mailing Address - Phone:336-694-4104
Mailing Address - Fax:
Practice Address - Street 1:1493 MAIN ST
Practice Address - Street 2:
Practice Address - City:YANCEYVILLE
Practice Address - State:NC
Practice Address - Zip Code:27379-8793
Practice Address - Country:US
Practice Address - Phone:336-694-4104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1194744342Medicaid