Provider Demographics
NPI:1104693811
Name:VILLAGE OF GILBERT PHARMACY, LLC
Entity type:Organization
Organization Name:VILLAGE OF GILBERT PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BOOK
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:318-907-2077
Mailing Address - Street 1:7659 GILBERT ST STE A
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:LA
Mailing Address - Zip Code:71336-3410
Mailing Address - Country:US
Mailing Address - Phone:318-907-2077
Mailing Address - Fax:
Practice Address - Street 1:7659 GILBERT ST STE A
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:LA
Practice Address - Zip Code:71336-3410
Practice Address - Country:US
Practice Address - Phone:318-907-2077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy