Provider Demographics
NPI:1568975464
Name:VDNR PHARMACY LLC
Entity Type:Organization
Organization Name:VDNR PHARMACY LLC
Other - Org Name:LIFELINE SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJESHWER
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:PINGILI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RPH
Authorized Official - Phone:410-203-1010
Mailing Address - Street 1:3233 CORPORATE CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2247
Mailing Address - Country:US
Mailing Address - Phone:410-203-1010
Mailing Address - Fax:410-203-1515
Practice Address - Street 1:3233 CORPORATE CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2247
Practice Address - Country:US
Practice Address - Phone:410-203-1010
Practice Address - Fax:410-203-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPW05133336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPW0513OtherPERMIT NUMBER