1255434528 NPI number — VG'S PHARMACY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255434528 NPI number — VG'S PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VG'S PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VG'S PHARMACY #2
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255434528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1341 N. M-52 HIGHWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWOSSO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-725-5141
Provider Business Mailing Address Fax Number:
989-729-0852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1341 N. M-52 HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWOSSO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-725-5141
Provider Business Practice Location Address Fax Number:
989-729-0852
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HIGGINS
Authorized Official First Name:
BRYON
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PHARMACY PRODUCT DIRECTOR
Authorized Official Telephone Number:
810-629-1383

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  5301004772 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2343438 . This is a "NABP/NCPDP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4074835 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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