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General NPI Number Information
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NPI Number | 1174078075
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Entity Type | Organization
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Legal Business Name | VPRP, INC.
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Dates
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Enumeration Date | 08/20/2016
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Last Update Date | 08/20/2016
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Provider Practice Location Address
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Address Line | 17821 SANTIAGO BLVD
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City | VILLA PARK
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State | CA
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Zip | 92861-4133
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Country | US
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Telephone | 714-998-3030
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Fax | 714-998-6060
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Provider Business Mailing Address
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Address Line | 17821 SANTIAGO BLVD
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City | VILLA PARK
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State | CA
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Zip | 92861-4133
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Country | US
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Telephone | 714-998-3030
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Fax | 714-998-6060
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Authorized Official
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Title or Position | CORP SECRETARY
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Name | TOBIAS PORTER
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Credential |
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Telephone | 714-998-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY53366
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License Number State | CA
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