Provider Demographics
NPI:1528104148
Name:VILLAGE FOODS LTD
Entity type:Organization
Organization Name:VILLAGE FOODS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-691-7160
Mailing Address - Street 1:3030 E 29TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2757
Mailing Address - Country:US
Mailing Address - Phone:979-846-8199
Mailing Address - Fax:979-846-0413
Practice Address - Street 1:3030 E 29TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2757
Practice Address - Country:US
Practice Address - Phone:979-846-8199
Practice Address - Fax:979-846-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX262153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145947Medicaid
2101873OtherPK