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NPI Code Detail

MEDICARE: VITALAB PHARMACY INC

MEDICARE: VITALAB PHARMACY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QI0500XInfusion Therapy Clinic/Center

General Provider Information

NPI Number : 1265938534
Entity Type Code : Organization
Provider Name (Legal Business Name) : VITALAB PHARMACY INC
Provider Business Mailing Address
First Line : 4045 E BELL RD STE 163
Second Line :
City : PHOENIX
State : AZ
Zip : 85032-2240
Country : US
Telephone Number : 602-971-6950
Fax Number : 602-404-2504
Provider Business Practice Location Address
First Line : 2120 W INA RD STE 100
Second Line :
City : TUCSON
State : AZ
Zip : 85741-5501
Country : US
Telephone Number : 602-346-0204
Fax Number :
Authorized Official
Title or Position : SR VP BUSINESS DEVELOPMENT
Name : PAUL VASILIAUSKAS
Credential :
Telephone Number : 602-971-6950
Provider Enumeration Date : 04/04/2018
Last Update Date : 09/22/2020

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Directions to “VITALAB PHARMACY INC ” Practice Location

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