Provider Demographics
NPI:1922793223
Name:VAXMED LLC
Entity Type:Organization
Organization Name:VAXMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:630-309-3719
Mailing Address - Street 1:1000 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-9307
Mailing Address - Country:US
Mailing Address - Phone:630-309-3719
Mailing Address - Fax:
Practice Address - Street 1:3033 OGDEN AVE STE 202
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1976
Practice Address - Country:US
Practice Address - Phone:630-309-3719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy