Healthcare Provider Details

I. General information

NPI: 1174544126
Provider Name (Legal Business Name): VVLS HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 WEST TABOR ROAD SUITE 102
PHILADELPHIA PA
19141
US

IV. Provider business mailing address

1335 W TABOR RD SUITE 102
PHILADELPHIA PA
19141
US

V. Phone/Fax

Practice location:
  • Phone: 215-927-6700
  • Fax: 215-924-0960
Mailing address:
  • Phone: 215-927-6700
  • Fax: 215-927-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP414761L
License Number StatePA

VIII. Authorized Official

Name: MR. LALIT C. CHERUKURI
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 215-927-6700