Provider Demographics
NPI:1578169322
Name:MOBILE VACCINATION SERVICES, LLC
Entity Type:Organization
Organization Name:MOBILE VACCINATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:704-604-2588
Mailing Address - Street 1:8410 PIT STOP CT NW STE 134
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8259
Mailing Address - Country:US
Mailing Address - Phone:877-829-8261
Mailing Address - Fax:
Practice Address - Street 1:8410 PIT STOP CT NW STE 134
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8259
Practice Address - Country:US
Practice Address - Phone:877-829-8261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy