Provider Demographics
NPI:1912001983
Name:VINA PHARMACY
Entity Type:Organization
Organization Name:VINA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:512-970-7326
Mailing Address - Street 1:4700 SETON CENTER PKWY
Mailing Address - Street 2:STE 115
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5295
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4700 SETON CENTER PKWY
Practice Address - Street 2:STE 115
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5295
Practice Address - Country:US
Practice Address - Phone:512-372-0440
Practice Address - Fax:512-372-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX252033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145713Medicaid
4542723OtherOTHER ID NUMBER-COMMERCIAL NUMBER