Provider Demographics
NPI:1891838272
Name:VIP PHARMACY INC
Entity Type:Organization
Organization Name:VIP PHARMACY INC
Other - Org Name:VIP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-573-0123
Mailing Address - Street 1:13193 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4179
Mailing Address - Country:US
Mailing Address - Phone:909-573-0123
Mailing Address - Fax:909-573-0111
Practice Address - Street 1:13193 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4179
Practice Address - Country:US
Practice Address - Phone:909-573-0123
Practice Address - Fax:909-573-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY483903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA483900Medicaid
2112251OtherPK
6021890001Medicare NSC