Provider Demographics
NPI:1992747778
Name:VILLAGE PHARMACY CORP
Entity type:Organization
Organization Name:VILLAGE PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:212-807-7566
Mailing Address - Street 1:407 BLEECKER ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2157
Mailing Address - Country:US
Mailing Address - Phone:212-807-7566
Mailing Address - Fax:212-924-6221
Practice Address - Street 1:407 BLEECKER ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-2157
Practice Address - Country:US
Practice Address - Phone:212-807-7566
Practice Address - Fax:212-924-6221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0316903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03524229Medicaid
3375587OtherNCPDP
NY03524229Medicaid
FV3694494OtherDEA