Provider Demographics
NPI:1174033583
Name:VECTRARX MAIL PHARMACY SERVICES, L.L.C.
Entity Type:Organization
Organization Name:VECTRARX MAIL PHARMACY SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:CACCIATORE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:520-405-5563
Mailing Address - Street 1:10860 N MAVINEE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10860 N MAVINEE DR STE 100
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9514
Practice Address - Country:US
Practice Address - Phone:520-360-9641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZY007390OtherARIZONA BOARD OF PHARMACY LIMITED SERVICE PHARMACY PERMIT NUMBER