Provider Demographics
NPI:1275148306
Name:VANG, VA (PHARMD)
Entity Type:Individual
Prefix:
First Name:VA
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 VICKSBURG LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1317
Mailing Address - Country:US
Mailing Address - Phone:763-253-8917
Mailing Address - Fax:
Practice Address - Street 1:3255 VICKSBURG LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1317
Practice Address - Country:US
Practice Address - Phone:763-253-8917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist