Reeseville Village Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

5761-042 Issued in WI

Legal business name

REESEVILLE VILLAGE PHARMACY LLC

Practice address

202 S. Main St.
Reeseville, WI 53579-0087

Phone

(920) 927-3305

Fax

(920) 927-3307

NPI assigned

Nov 13, 2006

Organization subpart

No

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

Authorized official

Name

Mr. James Lee Dykstra, R.PH,

Title

Sole Member LLC

Phone

(920) 927-3305

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Village HealthMart Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360022400000",
    "number": "1891866802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 S. MAIN ST.",
            "address_2": "P.O. BOX 87",
            "city": "REESEVILLE",
            "state": "WI",
            "postal_code": "535790087",
            "telephone_number": "920-927-3305",
            "fax_number": "920-927-3307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 S. MAIN ST.",
            "city": "REESEVILLE",
            "state": "WI",
            "postal_code": "535790087",
            "telephone_number": "920-927-3305",
            "fax_number": "920-927-3307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REESEVILLE VILLAGE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2013-02-05",
        "status": "A",
        "authorized_official_last_name": "DYKSTRA",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "SOLE MEMBER LLC",
        "authorized_official_telephone_number": "920-927-3305",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH,"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WI",
            "license": "5761-042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33098800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "5109005",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Village HealthMart Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paul Andres Hamre, RN
• Doris Lynn Holloway, RN
• Kayla Lynn Lambrecht, R.N.
• Gerald Turner, LMT

• Pharmacy in Reeseville, WI
• Providers in Reeseville, WI by specialty
• Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2013; 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.