Provider Demographics
NPI:1649851601
Name:VAX21 LLC
Entity type:Organization
Organization Name:VAX21 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-423-3862
Mailing Address - Street 1:3050 POST OAK BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-6512
Mailing Address - Country:US
Mailing Address - Phone:713-423-3862
Mailing Address - Fax:713-423-3863
Practice Address - Street 1:3050 POST OAK BLVD STE 510
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-6512
Practice Address - Country:US
Practice Address - Phone:713-423-3862
Practice Address - Fax:713-423-3863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No3336M0002XSuppliersPharmacyMail Order Pharmacy