Healthcare Provider Details

I. General information

NPI: 1184602690
Provider Name (Legal Business Name): VANDEL DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MAIN STREET
TORRINGTON WY
82240
US

IV. Provider business mailing address

3780 E 15TH STREET SUITE 102
LOVELAND CO
80538
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-2214
  • Fax: 307-532-7136
Mailing address:
  • Phone: 970-461-1975
  • Fax: 970-461-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberR10062
License Number StateWY

VIII. Authorized Official

Name: VICKILEE KNIGHT EINHELLIG
Title or Position: MANAGING PARTNER
Credential:
Phone: 970-461-1975