Provider Demographics
NPI:1174006399
Name:VILLAGE DISCOUNT PHARMACY
Entity type:Organization
Organization Name:VILLAGE DISCOUNT PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER /PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:GAMAL
Authorized Official - Middle Name:ABOUELWAFA
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:352-492-9333
Mailing Address - Street 1:3990 E SR 44 STE 207
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-7482
Mailing Address - Country:US
Mailing Address - Phone:352-492-9333
Mailing Address - Fax:352-399-6234
Practice Address - Street 1:3990 E ST 44 SUITE 207
Practice Address - Street 2:E SR44 SUITE 207
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785
Practice Address - Country:US
Practice Address - Phone:407-492-3041
Practice Address - Fax:352-399-6234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy