MEDICARE: VITAL RX LLC

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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	054.018134	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2138597	OTHER		PK

General Provider Information

NPI Number	:	1760418024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL RX LLC

Provider Business Mailing Address
First Line	:	2837 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-7403
Country	:	US
Telephone Number	:	773-862-1699
Fax Number	:	773-862-2350

Provider Business Practice Location Address
First Line	:	2837 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-7403
Country	:	US
Telephone Number	:	773-862-1699
Fax Number	:	773-862-2350

Authorized Official
Title or Position	:	OWNER
Name	:	RICK SCHUMACHER
Credential	:
Telephone Number	:	773-862-1699

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	03/01/2017

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