1366473209 NPI number — VILAS LONG TERM CARE PHARMACY

Table of content: (NPI 1366473209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366473209 NPI number — VILAS LONG TERM CARE PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILAS LONG TERM CARE PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMUNITY PHARMACIES, INC.
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366473209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIERRE
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57501-1215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-224-0907
Provider Business Mailing Address Fax Number:
605-224-8027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 EAST DAKOTA AVE
Provider Second Line Business Practice Location Address:
SUITE #2
Provider Business Practice Location Address City Name:
PIERRE
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-224-0907
Provider Business Practice Location Address Fax Number:
605-224-8027
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEPHENS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
605-224-4538

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  200-1685 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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