Healthcare Provider Details

I. General information

NPI: 1518996545
Provider Name (Legal Business Name): VONS COMPANIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 E HORIZON RIDGE PKWY
HENDERSON NV
89002-7908
US

IV. Provider business mailing address

250 E PARKCENTER BLVD MAILSTOP SEC 2-B
BOISE ID
83706-3940
US

V. Phone/Fax

Practice location:
  • Phone: 702-564-1425
  • Fax: 702-564-8545
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH02102
License Number StateNV

VIII. Authorized Official

Name: TIFFANY ELIOPULOS
Title or Position: ASSISTANT MANAGER, ENROLLMENTS
Credential:
Phone: 208-395-3906