Provider Demographics
NPI:1942403308
Name:RAINBOW INCORP
Entity Type:Organization
Organization Name:RAINBOW INCORP
Other - Org Name:VITA DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO/PIC
Authorized Official - Prefix:
Authorized Official - First Name:TRUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-699-8990
Mailing Address - Street 1:816 E ARROWOOD RD STE D
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-5818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:816 E ARROWOOD RD STE D
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-5818
Practice Address - Country:US
Practice Address - Phone:704-551-8770
Practice Address - Fax:704-551-8707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC095443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3408665OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NC0602112Medicaid