Provider Demographics
NPI:1245860535
Name:VIVMEDS PHARMACY CORPORATION
Entity type:Organization
Organization Name:VIVMEDS PHARMACY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:DOMINIC
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:940-226-4849
Mailing Address - Street 1:3303 UNICORN LAKE BLVD # 280
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0160
Mailing Address - Country:US
Mailing Address - Phone:940-226-4849
Mailing Address - Fax:940-226-4859
Practice Address - Street 1:3303 UNICORN LAKE BLVD # 280
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0160
Practice Address - Country:US
Practice Address - Phone:940-226-4849
Practice Address - Fax:940-226-4859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-25
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy