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General NPI Number Information
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NPI Number | 1417259326
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Entity Type | Organization
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Legal Business Name | VG WELLNESS PHARMACY, INC.
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 440 S VERMONT AVE STE 109
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City | LOS ANGELES
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State | CA
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Zip | 90020-1987
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Country | US
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Telephone | 213-388-4100
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Fax | 213-388-4200
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Provider Business Mailing Address
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Address Line | 5028 BOSTON AVENUE
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City | GLENDALE
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State | CA
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Zip | 91214-1013
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Country | US
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Telephone | 818-279-5407
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Fax | 213-388-4200
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MS. KYUNGJOO KOO
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Credential | RPH
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Telephone | 213-388-4100
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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 |
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License Number State |
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