Organization
MEDVANTX,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNY HEINE (DIRECTOR OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
3330 PEACH ST, SUITE 107, ERIE, PA 16508-2769
(814) 877-5500
Mailing address
5810 NANCY RIDGE DR, SUITE 100, SAN DIEGO, CA 92121-2834
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
MD053809L
PA
Other
Enumeration date
02/14/2007
Last updated
08/22/2020
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