Healthcare Provider Details

I. General information

NPI: 1972616308
Provider Name (Legal Business Name): REISZ PHARMACEUTICALS VITAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 MAYFAIR DR MAYFAIR SQUARE PROFESSIONAL BUILDING
OWENSBORO KY
42301-4557
US

IV. Provider business mailing address

PO BOX 5047
MERIDIAN MS
39302-5047
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-7379
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberP02023
License Number StateKY

VIII. Authorized Official

Name: E REISZ
Title or Position: OWNER
Credential:
Phone: 270-683-7379