Provider Demographics
NPI:1013202829
Name:VANG PHARMACY INC
Entity Type:Organization
Organization Name:VANG PHARMACY INC
Other - Org Name:VANGS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:916-393-5961
Mailing Address - Street 1:7260 E SOUTHGATE DR STE E
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2609
Mailing Address - Country:US
Mailing Address - Phone:916-393-5961
Mailing Address - Fax:916-393-5972
Practice Address - Street 1:7260 E SOUTHGATE DR STE E
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2609
Practice Address - Country:US
Practice Address - Phone:916-393-5961
Practice Address - Fax:916-393-5972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY506373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1013202829Medicaid
2130892OtherPK