Provider Demographics
NPI:1477607752
Name:VILLAGE FERTILITY PHARMACY, INC.
Entity Type:Organization
Organization Name:VILLAGE FERTILITY PHARMACY, INC.
Other - Org Name:VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SILKES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:781-890-8998
Mailing Address - Street 1:40 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1132
Mailing Address - Country:US
Mailing Address - Phone:781-890-8998
Mailing Address - Fax:781-890-5997
Practice Address - Street 1:1 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1168
Practice Address - Country:US
Practice Address - Phone:401-334-1600
Practice Address - Fax:401-334-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI003283336C0003X, 3336C0004X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Not Answered3336S0011XSuppliersPharmacySpecialty Pharmacy