Provider Demographics
NPI:1467750430
Name:VMM, INC.
Entity Type:Organization
Organization Name:VMM, INC.
Other - Org Name:MEDICINE SHOPPE #0736
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VORNDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-273-7360
Mailing Address - Street 1:1006 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-6419
Mailing Address - Country:US
Mailing Address - Phone:405-273-7360
Mailing Address - Fax:405-273-4384
Practice Address - Street 1:1006 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6419
Practice Address - Country:US
Practice Address - Phone:405-273-7360
Practice Address - Fax:405-273-4384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK102995332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100239580 BMedicaid
OK3715921OtherNCPDP
OK0260070001Medicare NSC