Healthcare Provider Details

I. General information

NPI: 1114032430
Provider Name (Legal Business Name): VICKY K VANOSS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S MAIN ST OKULEYS PHARMACY
CONTINENTAL OH
45831-9004
US

IV. Provider business mailing address

196 EASTOWNE DR
OTTAWA OH
45875
US

V. Phone/Fax

Practice location:
  • Phone: 419-596-3898
  • Fax: 419-596-3909
Mailing address:
  • Phone: 419-615-3957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03122287
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: