Healthcare Provider Details

I. General information

NPI: 1497585228
Provider Name (Legal Business Name): VET WELL RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 W NORTHWEST HWY STE 118
GRAPEVINE TX
76051-6993
US

IV. Provider business mailing address

2150 W NORTHWEST HWY STE 118
GRAPEVINE TX
76051-6993
US

V. Phone/Fax

Practice location:
  • Phone: 682-223-1044
  • Fax: 682-223-1412
Mailing address:
  • Phone: 682-223-1044
  • Fax: 682-223-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0207X
TaxonomyCompounded Sterile Preparations Pharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HAIVAN IMMLER
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 682-223-1044