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General NPI Number Information
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NPI Number | 1649821091
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Entity Type | Organization
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Legal Business Name | NEWPATH VITAL RX INC.
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 425 LAKE ST STE A
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City | ANTIOCH
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State | IL
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Zip | 60002-1464
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Country | US
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Telephone | 224-788-8557
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Fax | 224-788-8798
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Provider Business Mailing Address
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Address Line | 425 LAKE ST STE A
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City | ANTIOCH
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State | IL
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Zip | 60002-1464
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Country | US
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Telephone | 224-788-8557
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Fax | 224-788-8798
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Authorized Official
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Title or Position | PIC
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Name | MS. NISHA JANI
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Credential |
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Telephone | 224-656-5797
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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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