Provider Demographics
NPI:1982889812
Name:VANTAGERX DISPENSING SERVICES, LLC
Entity Type:Organization
Organization Name:VANTAGERX DISPENSING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-807-4113
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-0304
Mailing Address - Country:US
Mailing Address - Phone:877-321-6337
Mailing Address - Fax:877-321-6337
Practice Address - Street 1:2200 DOUGLAS BLVD STE 100A
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3862
Practice Address - Country:US
Practice Address - Phone:877-321-6337
Practice Address - Fax:877-321-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site