Vine Pharmacy

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

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

Organization subpart

No

Name

Charlotte K Moss, PHARMD

Title

Owner

Phone

(570) 925-2500

Tax ID family

Vine Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Vine Pharmacy

  • Long Term Care Pharmacy
  • Benton, PA
  • NPI 1154166817
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 26, 2022.

{
    "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": []
}

• Richard A Prisuta, D.O.
• Ekatherina Shaportova
• Sugarloaf Community Rescue &
• Sugarloaf Community Rescue & Ambulance Association
• Vine Pharmacy
• Vine Pharmacy
• Cortney B Young, RDH

• All providers in Benton, PA
• Family Medicine Physician in Pennsylvania

• 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.

Verify at the official NPI Registry.