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General NPI Number Information
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NPI Number | 1750789301
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Entity Type | Organization
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Legal Business Name | VITALITY PLUS PA
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 300 BILLINGSLEY RD SUITE 204
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City | CHARLOTTE
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State | NC
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Zip | 28211-1075
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Country | US
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Telephone | 704-334-6488
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Fax |
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Provider Business Mailing Address
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Address Line | 300 BILLINGSLEY RD SUITE 204
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City | CHARLOTTE
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State | NC
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Zip | 28211-1075
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Country | US
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Telephone | 704-334-6488
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Fax |
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Authorized Official
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Title or Position | DISPENSING PHYSICIAN
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Name | DR. MICHAEL TROMBLEY
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Credential |
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Telephone | 704-334-6488
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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 | 9400162
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License Number State | NC
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