Provider Demographics
NPI:1497377543
Name:VAXON LLC
Entity Type:Organization
Organization Name:VAXON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FADALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-756-7886
Mailing Address - Street 1:3201 EDWARDS MILL RD STE 141
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5371
Mailing Address - Country:US
Mailing Address - Phone:919-756-7886
Mailing Address - Fax:828-282-2442
Practice Address - Street 1:4057 REUNION CREEK PKWY
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-9209
Practice Address - Country:US
Practice Address - Phone:919-887-7999
Practice Address - Fax:828-282-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
No333600000XSuppliersPharmacyGroup - Multi-Specialty