Provider Demographics
NPI:1639589690
Name:VENDOR PRO CORPORATION
Entity Type:Organization
Organization Name:VENDOR PRO CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-743-8396
Mailing Address - Street 1:804 N 19TH AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6928
Mailing Address - Country:US
Mailing Address - Phone:866-743-8396
Mailing Address - Fax:
Practice Address - Street 1:804 N 19TH AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6928
Practice Address - Country:US
Practice Address - Phone:866-743-8396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-WDD-LIC-21852333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy