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General NPI Number Information
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NPI Number | 1710475629
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Entity Type | Organization
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Legal Business Name | VPK SHAH MEDS LLC
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 4720 PUDDLEDOCK RD
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City | PRINCE GEORGE
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State | VA
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Zip | 23875-1275
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Country | US
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Telephone | 804-793-8000
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Fax | 804-793-8001
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Provider Business Mailing Address
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Address Line | 4720 PUDDLEDOCK RD
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City | PRINCE GEORGE
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State | VA
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Zip | 23875-1275
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Country | US
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Telephone | 804-793-8000
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Fax | 804-793-8001
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Authorized Official
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Title or Position | OWNER/PRESIDENT/AO
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Name | VIPUL SHAH
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Credential |
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Telephone | 301-943-6183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0201004837
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License Number State | VA
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