Healthcare Provider Details

I. General information

NPI: 1013021005
Provider Name (Legal Business Name): VASA-RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 ALLEN RD
ALLEN PARK MI
48101-2009
US

IV. Provider business mailing address

7125 ALLEN RD
ALLEN PARK MI
48101-2009
US

V. Phone/Fax

Practice location:
  • Phone: 313-386-2273
  • Fax: 313-386-7979
Mailing address:
  • Phone: 313-386-2273
  • Fax: 313-389-7979

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 Number5301008404
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VINAY SHAH
Title or Position: CO OWNER
Credential: RPH
Phone: 732-891-1727