Provider Demographics
NPI:1376849810
Name:VIP PHARMACY INC
Entity type:Organization
Organization Name:VIP PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-961-1629
Mailing Address - Street 1:5669 NW 195TH DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-6112
Mailing Address - Country:US
Mailing Address - Phone:305-961-1629
Mailing Address - Fax:305-623-3858
Practice Address - Street 1:5669 NW 195TH DR
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-6112
Practice Address - Country:US
Practice Address - Phone:305-961-1629
Practice Address - Fax:305-623-3858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5704057OtherNCPDP PROVIDER IDENTIFICATION NUMBER