MEDICARE: VCP OHIO II, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy	02-1678300 00634	OH

General Provider Information

NPI Number	:	1386774123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VCP OHIO II, LLC

Provider Business Mailing Address
First Line	:	9820 WINDISCH RD.
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3806
Country	:	US
Telephone Number	:	513-407-5365
Fax Number	:	513-407-5382

Provider Business Practice Location Address
First Line	:	9820 WINDISCH RD.
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3806
Country	:	US
Telephone Number	:	513-407-5365
Fax Number	:	513-407-5382

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH PATRICK MANDL
Credential	:
Telephone Number	:	513-407-5365

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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