Provider Demographics
NPI:1205841822
Name:VANS INSTITUTIONAL PHARMACY INC
Entity Type:Organization
Organization Name:VANS INSTITUTIONAL PHARMACY INC
Other - Org Name:VANS INSTITUTIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE/ CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:HASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:731-588-5138
Mailing Address - Street 1:154 MOUNT PELIA RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3812
Mailing Address - Country:US
Mailing Address - Phone:731-588-5138
Mailing Address - Fax:731-588-5137
Practice Address - Street 1:154 MOUNT PELIA RD
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3812
Practice Address - Country:US
Practice Address - Phone:731-588-5138
Practice Address - Fax:731-588-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3317333600000X
KYTN19473336I0012X
AROS023703336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR196634407Medicaid
KY7100357450Medicaid
2094492OtherPK
TN1454897Medicaid
5241480001Medicare NSC