Provider Demographics
NPI:1508162017
Name:VIP PHARMACY OF LAKE WORTH
Entity Type:Organization
Organization Name:VIP PHARMACY OF LAKE WORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-951-6800
Mailing Address - Street 1:3093 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3631
Mailing Address - Country:US
Mailing Address - Phone:561-433-9933
Mailing Address - Fax:561-433-9969
Practice Address - Street 1:3093 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3631
Practice Address - Country:US
Practice Address - Phone:561-433-9933
Practice Address - Fax:561-433-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH25221333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy