Provider Demographics
NPI:1942242516
Name:V C ENTERPRISES INC
Entity Type:Organization
Organization Name:V C ENTERPRISES INC
Other - Org Name:VICTOR'S REGENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, AO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-877-1620
Mailing Address - Street 1:1643 ISLETA BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-4633
Mailing Address - Country:US
Mailing Address - Phone:505-877-1620
Mailing Address - Fax:505-877-3309
Practice Address - Street 1:1643 ISLETA BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-4633
Practice Address - Country:US
Practice Address - Phone:505-877-1620
Practice Address - Fax:505-877-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NMPH000029863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2056417OtherPK
NM57687Medicaid
2056417OtherPK