Provider Demographics
NPI:1770892762
Name:VIOPEG PHARMACY
Entity type:Organization
Organization Name:VIOPEG PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:OGECHI
Authorized Official - Middle Name:VIVIAN
Authorized Official - Last Name:MEZU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:443-272-7641
Mailing Address - Street 1:9916 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-1804
Mailing Address - Country:US
Mailing Address - Phone:443-272-7641
Mailing Address - Fax:
Practice Address - Street 1:9916 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-1804
Practice Address - Country:US
Practice Address - Phone:443-272-7641
Practice Address - Fax:443-272-7649
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:D'ROKECH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-25
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty