Provider Demographics
NPI:1780446161
Name:VILLAGE PARK PHARMACY LLC
Entity type:Organization
Organization Name:VILLAGE PARK PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-793-2800
Mailing Address - Street 1:24420 FM 1314 RD STE 13
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-5490
Mailing Address - Country:US
Mailing Address - Phone:281-747-7164
Mailing Address - Fax:
Practice Address - Street 1:24420 FM 1314 RD STE 13
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-5490
Practice Address - Country:US
Practice Address - Phone:281-747-7164
Practice Address - Fax:346-423-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy