Basic Information
| Provider Information | |||||||||
| NPI: | 1427489574 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VMC PHARMACY AT STONEGATE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4303 VICTORY DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787047507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124623627 | ||||||||
| FaxNumber: | 5124623431 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 W WILLIAM CANNON DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787455281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122762595 | ||||||||
| FaxNumber: | 5122847577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2013 | ||||||||
| LastUpdateDate: | 02/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | HOLLE | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5124623627 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | 28906 | TX | N | Suppliers | Pharmacy | 3336C0004X | 28906 | TX | N | Suppliers | Pharmacy | Compounding Pharmacy | 3336C0003X | 28906 | TX | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.