MEDICARE: VANDEL DRUG LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1215688049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANDEL DRUG LLC

Provider Business Mailing Address
First Line	:	3780 E 15TH ST STE 102
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-8768
Country	:	US
Telephone Number	:	970-481-9668
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 MAIN ST
Second Line	:
City	:	TORRINGTON
State	:	WY
Zip	:	82240-2708
Country	:	US
Telephone Number	:	307-532-2214
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE MGR.
Name	:	HEATHER ROBINSON
Credential	:
Telephone Number	:	970-481-9668

Provider Enumeration Date	:	01/13/2022
Last Update Date	:	01/13/2022

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