Organization
VONS COMPANIES INC
Active
Other names
VONS PHARMACY #2614
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
7405 S DURANGO DR, LAS VEGAS, NV 89113-3605
(702) 407-2524
(702) 407-2516
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH01907
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10053165
—
NV
01
—
2051087
PK
—
Enumeration date
07/02/2006
Last updated
10/04/2018
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