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| Type | Company | [sources] | |||
|---|---|---|---|---|---|
| Name | VT Pharmacy, Inc. | [sources] | |||
| Incorporation date | not available | [sources] | |||
| Jurisdiction | not available | [sources] | |||
| Country | United States | [sources] | |||
| NPI | 1033106083 | [sources] | |||
| Registration number | PHA220060 · PHY 22006 | [sources] | |||
| Sector | Entity/Corporation | [sources] | |||
| Address | 19300 Vanowen Street, Reseda, CA, 91335 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.
United States · DHCS
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| Linked to | ||||
|---|---|---|---|---|
| Object | Role | Start date | End date | |
| Victory Tampa Medical Pharmacy, Debarred entity | - | - | - | |