Provider Demographics
NPI:1689962821
Name:VILLAGE PHARMACY 2
Entity Type:Organization
Organization Name:VILLAGE PHARMACY 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRKLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-698-0800
Mailing Address - Street 1:29811 WALKER SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:PORT VINCENT
Mailing Address - State:LA
Mailing Address - Zip Code:70726
Mailing Address - Country:US
Mailing Address - Phone:225-698-0800
Mailing Address - Fax:225-698-3007
Practice Address - Street 1:29811 WALKER SOUTH RD
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785
Practice Address - Country:US
Practice Address - Phone:225-698-0800
Practice Address - Fax:225-698-3007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6278251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health