Provider Demographics
NPI:1285629105
Name:VANDEL DRUGS, INC.
Entity type:Organization
Organization Name:VANDEL DRUGS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:VANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-532-2214
Mailing Address - Street 1:2041 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-2708
Mailing Address - Country:US
Mailing Address - Phone:307-532-2214
Mailing Address - Fax:307-532-2298
Practice Address - Street 1:2041 MAIN ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-2708
Practice Address - Country:US
Practice Address - Phone:307-532-2214
Practice Address - Fax:307-532-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5200922332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY5200922OtherNABP #
WYAV4536895OtherDEA #
WY=========OtherTAX ID #
WY0633270001Medicare ID - Type Unspecified