OrganizationVillage Pharmacy, L.L.C.PharmacySuppliersPractice Address560 Weathersby Rd, Suite 170, Hattiesburg, MS 39402-1164(601) 296-0807PECOS EnrollmentBased on the most recent information from CMS, provider Village Pharmacy, L.L.C. does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1760409585Provider TypeOrganizationFull NameVillage Pharmacy, L.L.C.SubpartNoEnumeration Date7/16/2006Last Updated8/22/2020Contact InformationPractice LocationPractice Address560 Weathersby Rd, Suite 170, Hattiesburg, MS 39402-1164Phone(601) 296-0807Fax(601) 450-0424Mailing LocationMailing Address560 Weathersby Rd, Suite 170, Hattiesburg, MS 39402-1164Phone(601) 296-0807Fax(601) 450-0424Authorized OfficialNameBrinson, Richard (Pharmacist/Owner)Phone(601) 296-0807Provider TaxonomiesCodeDescriptionLicenseCode3336C0003XPrimaryDescriptionPharmacySuppliersLicense04114-01VHMississippiProvider IdentifiersIDDescriptionIssuerIDNABPDescriptionOtherIssuer2519239MississippiID0330382DescriptionMedicaidIssuerUnlistedMississippiID04114-01VHDescriptionOtherIssuerSTATE PERMIT IDMississippi