Vilonia Family Pharmacy Inc
Organization Active NPI Community/Retail Pharmacy · Vilonia, AR
NPI 1033558689 · NPPES record last updated Jun 27, 2024
Key facts
- NPI
- 1033558689
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- AR20721 (AR)
- Legal business name
- VILONIA FAMILY PHARMACY INC
- Practice address
- 1122 Main St Ste 14
Vilonia, AR 72173-8902 - Phone
- (501) 796-2204
- Fax
- (501) 796-2208
- NPI assigned
- Jun 17, 2013
- Organization subpart
- No
Authorized official
- Name
- Tahnya Harris
- Title
- Pharmacist/Owner
- Phone
- (501) 796-2204
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140725000670 | AR | Part B Supplier - Mass Immunization (Roster Biller Only) | 1355567421 | Practice locations: Vilonia, AR |
| O20200727000123 | AR | Part B Supplier - Pharmacy | 1355567421 | Practice locations: Vilonia, AR |
National Provider Directory
Locations
1122 Main St
Ste 14
Vilonia, AR 72173
Phone (501) 796-2204
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | AR20721 | AR | Yes |
Addresses
Primary practice location
1122 Main St Ste 14
Vilonia, AR 72173-8902
Mailing address
1122 Main St Ste 14
Vilonia, AR 72173-8902
Phone (501) 796-2204
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2140834 | Other | PK | |
| 198378407 | Medicaid | AR |
Other names
- VILONIA FAMILY PHARMACY
Other providers in Vilonia, AR
- Regina Stone Thomas
- United Methodist Behavioral Health System, Inc
- Vilonia Chiropractic
- Vilonia Drug Inc
- Vilonia Family Dental PLLC
- Vilonia Family Pharmacy Inc LTC
- Vilonia School District
- VTS Inc
- Brittany Leigh White
- Morgan Wilkerson
All providers in Vilonia, AR · Community/Retail Pharmacy in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.