Provider Demographics
NPI:1811225352
Name:VSR HEALTHCARE, INCORPORATED
Entity type:Organization
Organization Name:VSR HEALTHCARE, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER - PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN SANT
Authorized Official - Suffix:
Authorized Official - Credentials:BSP
Authorized Official - Phone:520-461-1125
Mailing Address - Street 1:305 S EUCLID AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-6649
Mailing Address - Country:US
Mailing Address - Phone:520-461-1125
Mailing Address - Fax:520-461-1126
Practice Address - Street 1:305 S EUCLID AVE STE 111
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-6649
Practice Address - Country:US
Practice Address - Phone:520-461-1125
Practice Address - Fax:520-461-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
AZY0052233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2125468OtherPK
AZ545160Medicaid