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NPI Code Detail

MEDICARE: VONS COMPANIES INC

MEDICARE: VONS 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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail PharmacyPHY52224CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11999965OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508895558
Entity Type Code : Organization
Provider Name (Legal Business Name) : VONS COMPANIES INC
Provider Business Mailing Address
First Line : 250 E PARKCENTER BLVD
Second Line : MAILSTOP SEC 2-B
City : BOISE
State : ID
Zip : 83706-3940
Country : US
Telephone Number : 208-395-6200
Fax Number : 623-282-3834
Provider Business Practice Location Address
First Line : 4733 E PALM CANYON DR
Second Line :
City : PALM SPRINGS
State : CA
Zip : 92264-5219
Country : US
Telephone Number : 760-324-8269
Fax Number : 760-202-3432
Authorized Official
Title or Position : ASSISTANT MANAGER, ENROLLMENTS
Name : TIFFANY ELIOPULOS
Credential :
Telephone Number : 208-395-3906
Provider Enumeration Date : 07/02/2006
Last Update Date : 11/01/2018

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Directions to “VONS COMPANIES INC ” Practice Location

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