Provider Demographics
NPI:1801548169
Name:VISIONMEDMD LLC
Entity type:Organization
Organization Name:VISIONMEDMD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMUBARAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-415-9196
Mailing Address - Street 1:9830 S 51ST ST STE B113
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5696
Mailing Address - Country:US
Mailing Address - Phone:480-590-0281
Mailing Address - Fax:480-572-1083
Practice Address - Street 1:9830 S 51ST ST STE B113
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5696
Practice Address - Country:US
Practice Address - Phone:480-590-0281
Practice Address - Fax:480-572-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy