Healthcare Provider Details

I. General information

NPI: 1407355480
Provider Name (Legal Business Name): VITAL RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 CAHABA VALLEY PKWY
PELHAM AL
35124-1146
US

IV. Provider business mailing address

237 CAHABA VALLEY PKWY
PELHAM AL
35124-1146
US

V. Phone/Fax

Practice location:
  • Phone: 866-209-5540
  • Fax:
Mailing address:
  • Phone: 866-209-5540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JASON FLEBOTTE
Title or Position: PIC/AUTHORIZED OFFICIAL
Credential:
Phone: 866-209-5540