Provider Demographics
NPI:1841639960
Name:VILLAGE APOTHECARY, INC.
Entity type:Organization
Organization Name:VILLAGE APOTHECARY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-922-0777
Mailing Address - Street 1:4440 N HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71909-9301
Mailing Address - Country:US
Mailing Address - Phone:501-922-0777
Mailing Address - Fax:866-448-0292
Practice Address - Street 1:134 S GEORGE
Practice Address - Street 2:
Practice Address - City:MT IDA
Practice Address - State:AR
Practice Address - Zip Code:71953
Practice Address - Country:US
Practice Address - Phone:870-867-0106
Practice Address - Fax:870-867-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMG01169332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119753716Medicaid
AR0762370002Medicare PIN