1174544126 NPI number — VVLS HEALTHCARE INC

Table of content: (NPI 1174544126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174544126 NPI number — VVLS HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VVLS HEALTHCARE 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:
RXD MEDICATION SERVICES
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:
1174544126
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1335 W TABOR RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-927-6700
Provider Business Mailing Address Fax Number:
215-927-3016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1335 WEST TABOR ROAD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-927-6700
Provider Business Practice Location Address Fax Number:
215-924-0960
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHERUKURI
Authorized Official First Name:
LALIT
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
215-927-6700

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PP414761L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0014169380001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3966908 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: PP414761L . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5509009 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1025030930001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000986907 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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