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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 PharmacyPH01907NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12051087OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982633913
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 :
Fax Number :
Provider Business Practice Location Address
First Line : 7405 S DURANGO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-3605
Country : US
Telephone Number : 702-407-2524
Fax Number : 702-407-2516
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 : 10/04/2018

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