Provider Demographics
NPI:1952312597
Name:VINA PHARMACY
Entity Type:Organization
Organization Name:VINA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-664-8659
Mailing Address - Street 1:969 WINDY HILL RD SE
Mailing Address - Street 2:STE N
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:969 WINDY HILL RD SE
Practice Address - Street 2:STE N
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2003
Practice Address - Country:US
Practice Address - Phone:770-805-0207
Practice Address - Fax:770-805-0209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0090393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154563OtherOTHER ID NUMBER
1154563OtherOTHER ID NUMBER-COMMERCIAL NUMBER