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General NPI Number Information
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NPI Number | 1962823054
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Entity Type | Organization
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Legal Business Name | VENDOR PRO CORPORATION
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Dates
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Enumeration Date | 12/17/2013
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 1627 W MAIN ST. SUITE 446
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City | BOZEMAN
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State | MT
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Zip | 59715-4011
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Country | US
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Telephone | 406-219-1922
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Fax | 406-219-1953
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Provider Business Mailing Address
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Address Line | 1627 W MAIN ST. SUITE 446
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City | BOZEMAN
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State | MT
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Zip | 59715-4011
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Country | US
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Telephone | 406-219-1922
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Fax | 406-219-1953
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Authorized Official
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Title or Position | MANAGER
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Name | MR. TYLER D BOHANNON
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Credential |
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Telephone | 406-219-1922
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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 | PHA-WDD-LIC-21852
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License Number State | MT
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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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