Provider Demographics
NPI:1528170545
Name:VG'S PHARMACY INC
Entity type:Organization
Organization Name:VG'S PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY PRODUCT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:C
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:810-629-1383
Mailing Address - Street 1:6764 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COTTRELLVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48039-2252
Mailing Address - Country:US
Mailing Address - Phone:810-765-3585
Mailing Address - Fax:810-765-3590
Practice Address - Street 1:6764 RIVER RD
Practice Address - Street 2:
Practice Address - City:COTTRELLVILLE
Practice Address - State:MI
Practice Address - Zip Code:48039-2252
Practice Address - Country:US
Practice Address - Phone:810-765-3585
Practice Address - Fax:810-765-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301007605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2364507OtherNABP/NCPDP
MI4726380Medicaid
1219420010Medicare NSC