Provider Demographics
NPI:1568782035
Name:VILLAGE PHARMACY
Entity Type:Organization
Organization Name:VILLAGE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY TECH
Authorized Official - Prefix:MS
Authorized Official - First Name:KARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-812-8222
Mailing Address - Street 1:2238 JONESBORO RD
Mailing Address - Street 2:STE D.
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-6734
Mailing Address - Country:US
Mailing Address - Phone:318-812-8222
Mailing Address - Fax:318-812-5804
Practice Address - Street 1:2238 JONESBORO RD
Practice Address - Street 2:STE D.
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-6734
Practice Address - Country:US
Practice Address - Phone:318-812-8222
Practice Address - Fax:318-812-5804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6263333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy