Healthcare Provider Details

I. General information

NPI: 1346236973
Provider Name (Legal Business Name): VERMONT V.O. PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 W OLYMPIC BLVD STE 104
LOS ANGELES CA
90006-2800
US

IV. Provider business mailing address

2655 W OLYMPIC BLVD STE 104
LOS ANGELES CA
90006-2800
US

V. Phone/Fax

Practice location:
  • Phone: 213-480-1503
  • Fax: 213-480-1551
Mailing address:
  • Phone: 213-480-1503
  • Fax: 213-480-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD LEE
Title or Position: CFO
Credential: PHARMD
Phone: 213-480-1503