=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407258031
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VINEYARD PHARMACY AND HEALTHCARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2014
-----------------------------------------------------
Last Update Date | 09/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6500 SW ARCHER RD STE H
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32608-4786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-505-3387
-----------------------------------------------------
Fax | 352-519-5999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6500 SW ARCHER RD STE H
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32608-4786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-505-3387
-----------------------------------------------------
Fax | 352-519-5999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHARMACY MANAGER
-----------------------------------------------------
Name | FRANK PEPRAH-ASANTE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-328-9281
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH28551
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------