Provider Demographics
NPI:1407938202
Name:PHARM VINITA ACQUISITION LLC
Entity Type:Organization
Organization Name:PHARM VINITA ACQUISITION LLC
Other - Org Name:V & V DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:FINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-256-2541
Mailing Address - Street 1:201 N SCRAPER ST
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-3209
Mailing Address - Country:US
Mailing Address - Phone:918-256-2541
Mailing Address - Fax:918-256-5295
Practice Address - Street 1:201 N SCRAPER ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-3209
Practice Address - Country:US
Practice Address - Phone:918-256-2541
Practice Address - Fax:918-256-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37-51463336C0003X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100234200AMedicaid
2081542OtherPK
0808530001Medicare NSC