=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730597394
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VM RX INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2014
-----------------------------------------------------
Last Update Date | 12/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18353 VANOWEN ST SUITE J
-----------------------------------------------------
City | RESEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91335-5498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-774-9300
-----------------------------------------------------
Fax | 818-774-9301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18353 VANOWEN ST SUITE J
-----------------------------------------------------
City | RESEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91335-5498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-774-9300
-----------------------------------------------------
Fax | 818-774-9301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MR. CHRISTIAN F HAINKA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-774-9300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY54667
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------