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General NPI Number Information
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NPI Number | 1831839513
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Entity Type | Organization
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Legal Business Name | VITAL RX OF LOUISIANA LLC
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Dates
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Enumeration Date | 03/30/2022
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 6200 LESLIE LANE
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City | LAKE CHARLES
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State | LA
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Zip | 70615
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Country | US
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Telephone | 877-264-8060
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Fax | 888-811-4564
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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 | DIRECTOR
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Name | JOSEPH TROY TATE
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Credential |
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Telephone | 877-264-8060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy 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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