Provider Demographics
NPI:1518368562
Name:VILLAGE APOTHECARY, INC.
Entity Type:Organization
Organization Name:VILLAGE APOTHECARY, INC.
Other - Org Name:MT IDA HOME MEDICAL & OXYGEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:501-922-0777
Mailing Address - Street 1:4440 N HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71909-9301
Mailing Address - Country:US
Mailing Address - Phone:501-922-0777
Mailing Address - Fax:501-922-0787
Practice Address - Street 1:136 S GEORGE STREET
Practice Address - Street 2:
Practice Address - City:MT IDA
Practice Address - State:AR
Practice Address - Zip Code:71957
Practice Address - Country:US
Practice Address - Phone:870-867-0106
Practice Address - Fax:870-867-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119753716Medicaid
AR119753716Medicaid