Provider Demographics
NPI:1578891669
Name:VILLAGE APOTHECARY
Entity Type:Organization
Organization Name:VILLAGE APOTHECARY
Other - Org Name:THE VILLAGE APOTHECARY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D, RPH
Authorized Official - Phone:910-639-0209
Mailing Address - Street 1:7305 NC HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:WHISPERING PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28327-8512
Mailing Address - Country:US
Mailing Address - Phone:910-949-3700
Mailing Address - Fax:910-949-3800
Practice Address - Street 1:7305 NC HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:WHISPERING PINES
Practice Address - State:NC
Practice Address - Zip Code:28327-8512
Practice Address - Country:US
Practice Address - Phone:910-949-3700
Practice Address - Fax:910-949-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10400333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122970OtherPK
NC0635708Medicaid
6460270001Medicare NSC