Provider Demographics
NPI:1174544126
Name:VVLS HEALTHCARE INC
Entity type:Organization
Organization Name:VVLS HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:LALIT
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHERUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-927-6700
Mailing Address - Street 1:1335 W TABOR RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141
Mailing Address - Country:US
Mailing Address - Phone:215-927-6700
Mailing Address - Fax:215-927-3016
Practice Address - Street 1:1335 WEST TABOR ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:215-927-6700
Practice Address - Fax:215-924-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414761L3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014169380001Medicaid
3966908OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PAPP414761LOtherSTATE LICENSE
NJ5509009Medicaid
PA1025030930001Medicaid
DE000986907Medicaid
DE000986907Medicaid
DE000986907Medicaid