Provider Demographics
NPI:1053470955
Name:VIK MANAGEMENT, INC.
Entity Type:Organization
Organization Name:VIK MANAGEMENT, INC.
Other - Org Name:ITC PHARMACY I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:FERNANDO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:671-646-6395
Mailing Address - Street 1:PO BOX 11468
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-1468
Mailing Address - Country:US
Mailing Address - Phone:671-646-6395
Mailing Address - Fax:671-646-4332
Practice Address - Street 1:590 S MARINE DR STE 126
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3531
Practice Address - Country:US
Practice Address - Phone:671-646-6395
Practice Address - Fax:671-646-4332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPCY-0143336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU671Medicaid