Healthcare Provider Details

I. General information

NPI: 1497377543
Provider Name (Legal Business Name): VAXON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 09/06/2023
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4057 REUNION CREEK PKWY
APEX NC
27539-9209
US

IV. Provider business mailing address

3201 EDWARDS MILL RD STE 141
RALEIGH NC
27612-5371
US

V. Phone/Fax

Practice location:
  • Phone: 919-887-7999
  • Fax: 828-282-2442
Mailing address:
  • Phone: 919-756-7886
  • Fax: 828-282-2442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARIAM FADALY
Title or Position: CEO
Credential:
Phone: 919-756-7886