Provider Demographics
NPI:1013323344
Name:VILAS LONG TERM CARE PHARMACY
Entity Type:Organization
Organization Name:VILAS LONG TERM CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:605-224-0907
Mailing Address - Street 1:200 E DAKOTA AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3198
Mailing Address - Country:US
Mailing Address - Phone:605-224-0907
Mailing Address - Fax:605-224-8027
Practice Address - Street 1:200 E DAKOTA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3198
Practice Address - Country:US
Practice Address - Phone:605-224-0907
Practice Address - Fax:605-224-8027
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY PHARMACIES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy