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General NPI Number Information
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NPI Number | 1457159097
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Entity Type | Organization
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Legal Business Name | VITAL PHARMACY LLC
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 997 BLANDING BLVD STE 5
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City | ORANGE PARK
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State | FL
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Zip | 32065-6790
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Country | US
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Telephone | 856-725-6905
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Fax |
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Provider Business Mailing Address
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Address Line | 39 NAVIGATORS RD
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City | SAINT JOHNS
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State | FL
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Zip | 32259-6323
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Country | US
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Telephone | 856-725-6905
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KHUSHBU BHALODIA
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Credential |
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Telephone | 856-725-6905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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