Healthcare Provider Details

I. General information

NPI: 1346566080
Provider Name (Legal Business Name): VEDIC PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W MAIN ST
DURHAM NC
27701-3604
US

IV. Provider business mailing address

114 W MAIN ST
DURHAM NC
27701-3604
US

V. Phone/Fax

Practice location:
  • Phone: 919-688-8978
  • Fax: 919-688-8072
Mailing address:
  • Phone: 919-688-8978
  • Fax: 919-688-8072

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 Number10528
License Number StateNC

VIII. Authorized Official

Name: VIPUL PATEL
Title or Position: OWNER
Credential:
Phone: 919-688-8978