Organization
NJ MED PA
Active
Parent organization
MEDVANTX INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX INC.
Authorized official
KENNY HEINE (VP OF OPERATIONS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
240 WILLIAMSON ST, SUITE 204, ELIZABETH, NJ 07202-3674
(908) 355-8877
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
25MA05507700
NJ
Other
Enumeration date
09/11/2014
Last updated
09/11/2014
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