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General NPI Number Information
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NPI Number | 1164534236
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Entity Type | Organization
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Legal Business Name | VG'S PHARMACY INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 4165 E COURT ST
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City | BURTON
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State | MI
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Zip | 48509-1717
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Country | US
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Telephone | 810-742-8326
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Fax | 810-742-3900
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Provider Business Mailing Address
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Address Line | 4165 E COURT ST
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City | BURTON
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State | MI
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Zip | 48509-1717
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Country | US
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Telephone | 810-742-8326
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Fax | 810-742-3900
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Authorized Official
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Title or Position | PHARMACY PRODUCT DIRECTOR
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Name | BRYON C HIGGINS
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Credential | R.PH.
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Telephone | 810-629-1383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5301005242
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License Number State | MI
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