Provider Demographics
NPI:1013572643
Name:VIC VENA PHARMACY, INC
Entity Type:Organization
Organization Name:VIC VENA PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VENA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-372-7761
Mailing Address - Street 1:1322 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2036
Mailing Address - Country:US
Mailing Address - Phone:716-372-7761
Mailing Address - Fax:716-372-4525
Practice Address - Street 1:1322 W STATE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2036
Practice Address - Country:US
Practice Address - Phone:716-372-7761
Practice Address - Fax:716-372-4525
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIC VENA PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy