MEDICARE: VINATOWN PHARMACY

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	3336C0003X	Community/Retail Pharmacy	11073	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4569464	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245217157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINATOWN PHARMACY

Provider Business Mailing Address
First Line	:	2117 CHENEVERT ST STE C
Second Line	:	STE C
City	:	HOUSTON
State	:	TX
Zip	:	77003-5845
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2117 CHENEVERT ST STE C
Second Line	:	STE C
City	:	HOUSTON
State	:	TX
Zip	:	77003-5845
Country	:	US
Telephone Number	:	713-651-1430
Fax Number	:	713-651-3947

Authorized Official
Title or Position	:	OWNER
Name	:	PHUONG DING
Credential	:	RPH
Telephone Number	:	713-651-1430

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	08/22/2020

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