Provider Demographics
NPI:1407258031
Name:VINEYARD PHARMACY AND HEALTHCARE SERVICES
Entity type:Organization
Organization Name:VINEYARD PHARMACY AND HEALTHCARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPRAH-ASANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-328-9281
Mailing Address - Street 1:6500 SW ARCHER RD STE H
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4786
Mailing Address - Country:US
Mailing Address - Phone:352-505-3387
Mailing Address - Fax:352-519-5999
Practice Address - Street 1:6500 SW ARCHER RD STE H
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4786
Practice Address - Country:US
Practice Address - Phone:352-505-3387
Practice Address - Fax:352-519-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0002X
FLPH285513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148101OtherPK