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General NPI Number Information
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NPI Number | 1356608772
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Entity Type | Organization
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Legal Business Name | VITAMEDMD LLC
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 04/23/2012
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Provider Practice Location Address
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Address Line | 951 BROKEN SOUND PKWY NW STE 320
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City | BOCA RATON
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State | FL
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Zip | 33487-3531
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Country | US
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Telephone | 561-961-1921
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Fax | 561-431-3389
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Provider Business Mailing Address
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Address Line | 951 BROKEN SOUND PKWY NW STE 320
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City | BOCA RATON
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State | FL
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Zip | 33487-3531
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Country | US
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Telephone | 561-961-1921
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Fax | 561-431-3389
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Authorized Official
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Title or Position | CHIEF STRATEGY OFFICER
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Name | MR. MITCHELL KRASSAN
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Credential |
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Telephone | 561-961-1921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 1376866
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License Number State | FL
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