Provider Demographics
NPI:1003538190
Name:VABBYPHARMA LLC
Entity Type:Organization
Organization Name:VABBYPHARMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:BOAHEMAA
Authorized Official - Last Name:POKU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:615-470-5062
Mailing Address - Street 1:3195 S MOUNT JULIET RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-1568
Mailing Address - Country:US
Mailing Address - Phone:615-470-5062
Mailing Address - Fax:514-470-5281
Practice Address - Street 1:3195 S MOUNT JULIET RD STE 104
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-1568
Practice Address - Country:US
Practice Address - Phone:615-470-5062
Practice Address - Fax:615-470-5281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ079870Medicaid