MEDICARE: THE VON'S COMPANIES INC

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	333600000X	Pharmacy	PH1171	NV
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2902636	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1386680999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE VON'S COMPANIES INC

Provider Business Mailing Address
First Line	:	20427 N 27TH AVE # MSC4551
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-3241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4239
Country	:	US
Telephone Number	:	702-645-3443
Fax Number	:	702-645-0433

Authorized Official
Title or Position	:	MANAGED CARE PLAN SPECIALIST
Name	:	MICHELLE ANN RIVERS
Credential	:	CPHT
Telephone Number	:	623-869-3524

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	11/17/2008

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Directions to “THE VON'S COMPANIES INC ” Practice Location

Language	Start Address	Practice Location

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