Provider Demographics
NPI:1588408843
Name:VILONIA FAMILY PHARMACY INC LTC
Entity type:Organization
Organization Name:VILONIA FAMILY PHARMACY INC LTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAHNYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-796-2204
Mailing Address - Street 1:1122 MAIN ST STE 14
Mailing Address - Street 2:
Mailing Address - City:VILONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72173-8902
Mailing Address - Country:US
Mailing Address - Phone:501-796-2204
Mailing Address - Fax:501-796-2208
Practice Address - Street 1:1122 MAIN ST STE 14
Practice Address - Street 2:
Practice Address - City:VILONIA
Practice Address - State:AR
Practice Address - Zip Code:72173-8902
Practice Address - Country:US
Practice Address - Phone:501-796-2204
Practice Address - Fax:501-796-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR198378407Medicaid