Provider Demographics
NPI:1952335937
Name:VANMOL LLC
Entity Type:Organization
Organization Name:VANMOL LLC
Other - Org Name:VAN MOL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-443-7073
Mailing Address - Street 1:9374 HIGHWAY 165 SOUTH
Mailing Address - Street 2:
Mailing Address - City:WOODWORTH
Mailing Address - State:LA
Mailing Address - Zip Code:71485-9786
Mailing Address - Country:US
Mailing Address - Phone:318-443-7073
Mailing Address - Fax:318-443-7052
Practice Address - Street 1:9374 HWY 165
Practice Address - Street 2:
Practice Address - City:WOODWORTH
Practice Address - State:LA
Practice Address - Zip Code:71485
Practice Address - Country:US
Practice Address - Phone:318-443-7073
Practice Address - Fax:318-443-7052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1932525OtherNCPD
LA2207288Medicaid
LA1288721Medicaid
LA5561040001Medicare ID - Type Unspecified