Healthcare Provider Details

I. General information

NPI: 1689318339
Provider Name (Legal Business Name): VINA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11207 N LAMAR BLVD STE A
AUSTIN TX
78753-3056
US

IV. Provider business mailing address

11207 N LAMAR BLVD STE A
AUSTIN TX
78753-3056
US

V. Phone/Fax

Practice location:
  • Phone: 512-977-8844
  • Fax: 512-977-8846
Mailing address:
  • Phone: 512-977-8844
  • Fax: 512-977-8846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: OMAR ALEJANDRO FUENTES CURIEL
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 512-350-4836