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General NPI Number Information
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NPI Number | 1710486410
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Entity Type | Organization
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Legal Business Name | VITAL RX LLC
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Dates
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Enumeration Date | 02/08/2018
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Last Update Date | 02/08/2018
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Provider Practice Location Address
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Address Line | 237 CAHABA VALLEY PKWY
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City | PELHAM
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State | AL
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Zip | 35124-1146
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Country | US
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Telephone | 866-209-5540
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Fax | 800-878-4160
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Provider Business Mailing Address
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Address Line | 237 CAHABA VALLEY PKWY
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City | PELHAM
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State | AL
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Zip | 35124-1146
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Country | US
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Telephone | 866-209-5540
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Fax | 800-878-4160
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | JASON FLEBOTTE
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Credential |
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Telephone | 866-209-5540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order 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 | 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 #4
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | 114629
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License Number State | AL
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