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General NPI Number Information
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NPI Number | 1508097668
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Entity Type | Organization
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Legal Business Name | VITAL SHRED
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 1000 E ATLANTIC BLVD STE 110
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City | POMPANO BEACH
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State | FL
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Zip | 33060-7459
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Country | US
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Telephone | 954-366-6519
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Fax | 954-366-6523
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Provider Business Mailing Address
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Address Line | 1000 E ATLANTIC BLVD STE:110
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City | POMPANO BEACH
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State | FL
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Zip | 33060-7479
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Country | US
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Telephone | 954-366-6519
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Fax | 954-366-6523
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | SERGE FRANCOIS
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Credential |
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Telephone | 954-366-6519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH24210
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License Number State | FL
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