Provider Demographics
NPI:1881680718
Name:V V L S PHARMACY LLC
Entity type:Organization
Organization Name:V V L S PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:GANSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-394-5671
Mailing Address - Street 1:3800 HORIZON BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4968
Mailing Address - Country:US
Mailing Address - Phone:215-494-9403
Mailing Address - Fax:215-357-2129
Practice Address - Street 1:3800 HORIZON BLVD
Practice Address - Street 2:STE 103
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4968
Practice Address - Country:US
Practice Address - Phone:215-494-9403
Practice Address - Fax:215-357-2129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA9-0001619333600000X
PAPP410111L3336C0003X
NY0336313336C0003X
NJ28RO000892003336C0003X
VA02140017473336C0003X
MDP069553336C0003X
FLPH292163336S0011X
DCNRX00006773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007473110001Medicaid
2125309OtherPK
PA1007473110001Medicaid