=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619052172
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VAXPRO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 HORIZON DR STE 101B
-----------------------------------------------------
City | VERONA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53593-1256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-241-4522
-----------------------------------------------------
Fax | 262-241-0626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 HORIZON DR STE 101B
-----------------------------------------------------
City | VERONA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53593-1256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-241-4522
-----------------------------------------------------
Fax | 262-241-0626
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. MINA SAID
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 262-241-4522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 10629-040
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------