Provider Demographics
NPI:1043531718
Name:VINELAND FOODLAND INC
Entity Type:Organization
Organization Name:VINELAND FOODLAND INC
Other - Org Name:ROGER'S FOODLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SEELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-429-9661
Mailing Address - Street 1:4039 HOLLYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9156
Mailing Address - Country:US
Mailing Address - Phone:269-408-1348
Mailing Address - Fax:269-408-1381
Practice Address - Street 1:4039 HOLLYWOOD RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9156
Practice Address - Country:US
Practice Address - Phone:269-408-1348
Practice Address - Fax:269-408-1381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010093993336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126116OtherPK
MI1043531718Medicaid