Healthcare Provider Details

I. General information

NPI: 1851143325
Provider Name (Legal Business Name): VPST CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15711 PACIFIC AVE S
TACOMA WA
98444-4675
US

IV. Provider business mailing address

15711 PACIFIC AVE S
TACOMA WA
98444-4675
US

V. Phone/Fax

Practice location:
  • Phone: 253-304-0547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PRAVEEN ELAMANCHILI
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 253-304-0547