Provider Demographics
NPI:1356330724
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
Practice Address - Street 2:SUITE 126
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3507
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:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPCY014261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU631Medicaid
GU631Medicaid