| Organization Name: | VILLAGE APOTHECARY AT WILLIAMSBURG |
| NPI Number: | 1043683568 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSEPH PETRICEK (PHARMACIST IN CHARGE) |
| Mailing Address: | 1609 Lafayette Rd Rm 23 Crawfordsville |
| State: | IN US |
| Postal Code: | 479331032 |
| Phone Number: | 7653640363 |
| Fax Number: | |
| NPI Enumeration Date: | 11/05/2015 |
| NPI Last Update Date: | 05/16/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |