1770892762 NPI number — VIOPEG PHARMACY

Table of content: (NPI 1770892762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770892762 NPI number — VIOPEG PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIOPEG PHARMACY
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:
VIOPEG PHARMACY
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:
1770892762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9916 LIBERTY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANDALLSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21133-1804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-272-7641
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9916 LIBERTY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANDALLSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21133-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-272-7641
Provider Business Practice Location Address Fax Number:
443-272-7649
Provider Enumeration Date:
09/25/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MEZU
Authorized Official First Name:
OGECHI
Authorized Official Middle Name:
VIVIAN
Authorized Official Title or Position:
OWNER/PHARMACY MANAGER
Authorized Official Telephone Number:
443-272-7641

Provider Taxonomy Codes

  • Taxonomy code: 183500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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