Provider Demographics
NPI:1346662814
Name:VITAMIN PHARMACY INC.
Entity Type:Organization
Organization Name:VITAMIN PHARMACY INC.
Other - Org Name:VITAMIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-888-0851
Mailing Address - Street 1:150-15 NORTHERN BLVD 1ST FLOOR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-888-0851
Mailing Address - Fax:718-888-9154
Practice Address - Street 1:150-15 NORTHERN BLVD 1ST FLOOR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-888-0851
Practice Address - Fax:718-888-9154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7262750001Medicare NSC