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General NPI Number Information
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NPI Number | 1326905845
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Entity Type | Organization
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Legal Business Name | VITASOURCE PHARMACY LLC
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 3806 AVENUE I STE 28
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City | ROSENBERG
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State | TX
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Zip | 77471-3951
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Country | US
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Telephone | 844-744-0101
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Fax | 844-744-0101
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Provider Business Mailing Address
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Address Line | 3806 AVENUE I STE 28
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City | ROSENBERG
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State | TX
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Zip | 77471-3951
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Country | US
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Telephone | 844-744-0101
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Fax | 844-744-0101
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Authorized Official
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Title or Position | OFFICER
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Name | SHAILENDRA GUPTA
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Credential | RPH
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Telephone | 844-744-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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