Active NPI
Vine Pharmacy
- Family Medicine Physician
- Benton, PA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- VINE PHARMACY
- Practice address
- 4375 Red Rock Rd
Benton, PA 17814-7948 - Phone
- (570) 925-2500
- Fax
- (570) 925-5771
- NPI assigned
- May 26, 2022
- Last updated
- May 26, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Charlotte K Moss, PHARMD
- Title
- Owner
- Phone
- (570) 925-2500
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
4375 Red Rock Rd
Benton, PA 17814-7948
Mailing address
4375 Red Rock Rd
Benton, PA 17814-7948
Phone (570) 925-2500
National Provider Directory
National Provider Directory- Tax ID family
- Vine Pharmacy
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Long Term Care Pharmacy
- Benton, PA
- NPI 1154166817
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Benton, PA
- NPI 1073023099
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653523200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1653523200000",
"number": "1679211882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4375 RED ROCK RD",
"city": "BENTON",
"state": "PA",
"postal_code": "178147948",
"telephone_number": "570-925-2500",
"fax_number": "570-925-5771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4375 RED ROCK RD",
"city": "BENTON",
"state": "PA",
"postal_code": "178147948",
"telephone_number": "570-925-2500",
"fax_number": "570-925-5771"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VINE PHARMACY",
"organizational_subpart": "NO",
"enumeration_date": "2022-05-26",
"last_updated": "2022-05-26",
"certification_date": "2022-05-26",
"status": "A",
"authorized_official_last_name": "MOSS",
"authorized_official_first_name": "CHARLOTTE",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "570-925-2500",
"authorized_official_credential": "PHARMD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Benton, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.