Provider Demographics
NPI:1932429271
Name:VILLAGE CLINIC AND RX LLC
Entity Type:Organization
Organization Name:VILLAGE CLINIC AND RX LLC
Other - Org Name:GULF GATE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-493-6500
Mailing Address - Street 1:2134 GULF GATE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-4813
Mailing Address - Country:US
Mailing Address - Phone:941-493-6500
Mailing Address - Fax:941-493-6552
Practice Address - Street 1:2134 GULF GATE DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4813
Practice Address - Country:US
Practice Address - Phone:941-493-6500
Practice Address - Fax:941-493-6552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003296000Medicaid