Healthcare Provider Details

I. General information

NPI: 1700108115
Provider Name (Legal Business Name): VEDIC PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 MARTIN LUTHER KING JR BLVD STE 104
RALEIGH NC
27610-3479
US

IV. Provider business mailing address

3058 WAKE FOREST RD
RALEIGH NC
27609-7844
US

V. Phone/Fax

Practice location:
  • Phone: 919-865-9993
  • Fax: 919-865-9998
Mailing address:
  • Phone: 919-865-9993
  • Fax: 919-865-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11305
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VIPUL PATEL
Title or Position: MANAGER
Credential:
Phone: 919-865-9993