Organization
VONS COMPANIES INC
Active
Other names
VONS PHARMACY #1795
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
2511 ANTHEM VILLAGE DR, HENDERSON, NV 89052-5504
(702) 617-4526
(702) 617-8974
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC 2-B, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH01662
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2051523
PK
—
05
—
2802334
—
NV
Enumeration date
06/21/2006
Last updated
11/01/2018
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