Village Drug Store

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

60002857A Issued in IN

Legal business name

VILLAGE DRUG STORE

Doing business as

Village Drug Store Inc

Practice address

1313 Homewood Dr
Crawfordsville, IN 47933-3341

Phone

(765) 364-0324

Fax

(765) 364-0325

NPI assigned

Jan 11, 2007

Organization subpart

No

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

Authorized official

Name

Joseph Frank Petricek, RPH

Title

Manager

Phone

(765) 364-0324

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• VILLAGE DRUG STORE INC Doing business as

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319587200000",
    "number": "1497805717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 661",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479330661",
            "telephone_number": "765-364-0324",
            "fax_number": "765-364-0325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 HOMEWOOD DR",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479333341",
            "telephone_number": "765-364-0324",
            "fax_number": "765-364-0325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE DRUG STORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2011-10-26",
        "status": "A",
        "authorized_official_last_name": "PETRICEK",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "FRANK",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "765-364-0324",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "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": "60002857A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1520887",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100294590A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VILLAGE DRUG STORE INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jonathon Wade
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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 Oct 26, 2011; 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.