Provider Demographics
NPI:1972054468
Name:VILLAGE APOTHECARY, INC.
Entity Type:Organization
Organization Name:VILLAGE APOTHECARY, INC.
Other - Org Name:DBA COLLEGE HILL DRUG & MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-620-4053
Mailing Address - Street 1:100 EAST ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854
Mailing Address - Country:US
Mailing Address - Phone:870-772-6969
Mailing Address - Fax:870-773-8657
Practice Address - Street 1:100 EAST ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854
Practice Address - Country:US
Practice Address - Phone:870-772-6969
Practice Address - Fax:870-773-8657
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE APOTHECARY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR00363332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1235114208OtherPHARMACY NPI
AR0400363OtherNCPDP
AR100230407Medicaid