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General NPI Number Information
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NPI Number | 1821005794
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Entity Type | Organization
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Legal Business Name | VITAL FACTOR INC
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 247-3 POST AVE.
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City | WESTBURY
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State | NY
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Zip | 11590
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Country | US
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Telephone | 516-333-1019
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Fax | 516-333-2279
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Provider Business Mailing Address
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Address Line | 247-3 POST AVE.
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City | WESTBURY
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State | NY
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Zip | 11590
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Country | US
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Telephone | 516-333-1019
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Fax | 516-333-2279
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Authorized Official
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Title or Position | PHARMCIST/ PRESIDENT
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Name | VINCENT JAMES FUSARO
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Credential | RPH
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Telephone | 516-333-1019
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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 | 024735
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License Number State | NY
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