MEDICARE: VIP PHARMACY 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	3336C0003X	Community/Retail Pharmacy	PHY48390	CA

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	2112251	OTHER		PK

General Provider Information

NPI Number	:	1891838272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIP PHARMACY INC

Provider Business Mailing Address
First Line	:	13193 CENTRAL AVE
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-4179
Country	:	US
Telephone Number	:	909-573-0123
Fax Number	:	909-573-0111

Provider Business Practice Location Address
First Line	:	13193 CENTRAL AVE
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-4179
Country	:	US
Telephone Number	:	909-573-0123
Fax Number	:	909-573-0111

Authorized Official
Title or Position	:	PIC
Name	:	ERIC SIRICH
Credential	:
Telephone Number	:	909-573-0123

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	02/14/2017

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Directions to “VIP PHARMACY INC ” Practice Location

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