Provider Demographics
NPI:1467564542
Name:VG'S PHARMACY INC
Entity Type:Organization
Organization Name:VG'S PHARMACY INC
Other - Org Name:VG'S PHARMACY #5
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY PRODUCT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:C
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:810-629-1383
Mailing Address - Street 1:2400 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8585
Mailing Address - Country:US
Mailing Address - Phone:517-548-7070
Mailing Address - Fax:517-548-9072
Practice Address - Street 1:2400 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8585
Practice Address - Country:US
Practice Address - Phone:517-548-7070
Practice Address - Fax:517-548-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301005797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4074871Medicaid
MI2350774OtherNABP/NCPDP
1219420005Medicare NSC