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General NPI Number Information
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NPI Number | 1639970478
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Entity Type | Organization
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Legal Business Name | VCISWV, LLC
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 5422 W THUNDERBIRD RD STE 18
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City | GLENDALE
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State | AZ
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Zip | 85306-4717
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Country | US
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Telephone | 602-848-2202
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Fax | 602-926-2500
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Provider Business Mailing Address
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Address Line | 5422 W THUNDERBIRD RD STE 18
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City | GLENDALE
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State | AZ
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Zip | 85306-4717
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Country | US
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Telephone | 602-848-2202
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Fax | 602-926-2500
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Authorized Official
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Title or Position | OWNER
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Name | BENJAMIN KRAWETZ
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Credential |
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Telephone | 602-848-2202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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