Provider Demographics
NPI:1639553464
Name:VILLAGE LONG TERM PHARMACY LLC
Entity Type:Organization
Organization Name:VILLAGE LONG TERM PHARMACY LLC
Other - Org Name:VILLAGE LONG TERM CARE PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:V
Authorized Official - Last Name:LONGHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-723-2528
Mailing Address - Street 1:204 THREE SPRINGS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3815
Mailing Address - Country:US
Mailing Address - Phone:304-723-2528
Mailing Address - Fax:855-933-2703
Practice Address - Street 1:204 THREE SPRINGS DR
Practice Address - Street 2:SUITE B
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3815
Practice Address - Country:US
Practice Address - Phone:304-723-2528
Practice Address - Fax:304-723-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVOP05522203336L0003X, 3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153229OtherPK
OH0145692Medicaid
WV3910007162Medicaid