Provider Demographics
NPI:1659374056
Name:VONO PHARMACY & CONVENIENT CENTER, INC.
Entity Type:Organization
Organization Name:VONO PHARMACY & CONVENIENT CENTER, INC.
Other - Org Name:VONO MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-522-2403
Mailing Address - Street 1:400 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5114
Mailing Address - Country:US
Mailing Address - Phone:217-522-2403
Mailing Address - Fax:217-757-9065
Practice Address - Street 1:400 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5114
Practice Address - Country:US
Practice Address - Phone:217-522-2403
Practice Address - Fax:217-757-9065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000097332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========006Medicaid
0239500001Medicare NSC