Healthcare Provider Details

I. General information

NPI: 1861991846
Provider Name (Legal Business Name): VITAL RX OF TENNESSEE LLC
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

150 COLLINS ST
MEMPHIS TN
38112-3814
US

IV. Provider business mailing address

150 COLLINS ST
MEMPHIS TN
38112-3814
US

V. Phone/Fax

Practice location:
  • Phone: 866-341-0200
  • Fax:
Mailing address:
  • Phone: 866-341-0200
  • 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: AMI JONES WITTBER
Title or Position: DIR OF PHARMACY/MANAGING MEMBER
Credential:
Phone: 901-443-2500