Healthcare Provider Details

I. General information

NPI: 1902144462
Provider Name (Legal Business Name): VITAL PHARMACARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 08/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 STAR BATT DR SUITE 200
ROCHESTER HILLS MI
48309-3712
US

IV. Provider business mailing address

1901 STAR BATT DR SUITE 200
ROCHESTER HILLS MI
48309-3712
US

V. Phone/Fax

Practice location:
  • Phone: 248-299-1701
  • Fax: 248-299-1702
Mailing address:
  • Phone: 248-299-1701
  • Fax: 248-299-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010041
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. STEVE S CAMISI
Title or Position: DIRECTOR OF PHARMACY SERVICES
Credential: PHARM.D.
Phone: 248-299-1701