# VINE PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154166817
- **Authorized official:** CHARLOTTE K MOSS RPH (PHARMACIST OWNER)
- **Authorized official phone:** (570) 925-2500

## Contact information

- **Practice address:** 4375 RED ROCK RD, BENTON, PA 17814-7948
- **Practice address phone:** (570) 925-2500
- **Mailing address:** 4375 RED ROCK RD, BENTON, PA 17814-7948
- **Mailing address phone:** (570) 925-2500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 06/26/2024
- **Last updated:** 06/26/2024