Provider Demographics
NPI:1396016945
Name:ST VINCENT DEPAUL VOLUNTEER COMMUNITY PHARMACY
Entity Type:Organization
Organization Name:ST VINCENT DEPAUL VOLUNTEER COMMUNITY PHARMACY
Other - Org Name:VIRGINIA ANDES VOLUNTEER COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:941-766-1584
Mailing Address - Street 1:21297 OLEAN BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-4609
Mailing Address - Country:US
Mailing Address - Phone:941-766-9570
Mailing Address - Fax:941-249-4609
Practice Address - Street 1:21297 OLEAN BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-4609
Practice Address - Country:US
Practice Address - Phone:941-766-9570
Practice Address - Fax:941-249-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH172083336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy