Healthcare Provider Details

I. General information

NPI: 1043531718
Provider Name (Legal Business Name): VINELAND FOODLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4039 HOLLYWOOD RD
SAINT JOSEPH MI
49085-9156
US

IV. Provider business mailing address

4039 HOLLYWOOD RD
SAINT JOSEPH MI
49085-9156
US

V. Phone/Fax

Practice location:
  • Phone: 269-408-1348
  • Fax: 269-408-1381
Mailing address:
  • Phone: 269-408-1348
  • Fax: 269-408-1381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009399
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAM SEELY
Title or Position: OWNER/SECRETARY
Credential:
Phone: 269-429-9661