Provider Demographics
NPI:1770514234
Name:VILAS PHARMACY
Entity type:Organization
Organization Name:VILAS PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-224-7334
Mailing Address - Street 1:100 MAC LN
Mailing Address - Street 2:SUITE #2
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3391
Mailing Address - Country:US
Mailing Address - Phone:605-224-7334
Mailing Address - Fax:605-945-4292
Practice Address - Street 1:100 MAC LN
Practice Address - Street 2:SUITE #2
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3391
Practice Address - Country:US
Practice Address - Phone:605-224-7334
Practice Address - Fax:605-945-4292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY PHARMACIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100-0970332B00000X, 3336C0002X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0966310004Medicare NSC