Healthcare Provider Details

I. General information

NPI: 1730637315
Provider Name (Legal Business Name): VANGUARD PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5724 SIGNAL HILL CT STE B
MILFORD OH
45150-1483
US

IV. Provider business mailing address

5724 SIGNAL HILL CT STE B
MILFORD OH
45150-1483
US

V. Phone/Fax

Practice location:
  • Phone: 513-373-3633
  • Fax:
Mailing address:
  • Phone: 513-373-3633
  • 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 TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberMOP.022650850-0
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANDREW JACKSON
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 513-239-5348