Village Apothecary at Williamsburg

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

60006523A Issued in IN

Legal business name

VILLAGE APOTHECARY AT WILLIAMSBURG

Doing business as

Village Apothecary at Williamsburg

Practice address

1609 Lafayette Rd RM 23
Crawfordsville, IN 47933-1032

Phone

(765) 364-0363

Fax

(765) 362-2436

NPI assigned

Nov 5, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joseph Petricek, BSPH

Title

Pharmacist in Charge

Phone

(765) 364-0363

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• Village Apothecary at Williamsburg Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475193600000",
    "number": "1043683568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 LAFAYETTE RD RM 23",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479331032",
            "telephone_number": "765-364-0363",
            "fax_number": "765-362-2436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 LAFAYETTE RD RM 23",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479331032",
            "telephone_number": "765-364-0363",
            "fax_number": "765-362-2436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE APOTHECARY AT WILLIAMSBURG",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-05",
        "last_updated": "2016-09-30",
        "status": "A",
        "authorized_official_last_name": "PETRICEK",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "765-364-0363",
        "authorized_official_credential": "BSPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "IN",
            "license": "60006523A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201348390A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2155103",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Village Apothecary at Williamsburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Long Term Care Pharmacy in Crawfordsville, IN
• Providers in Crawfordsville, IN by specialty
• Long Term Care Pharmacy in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.