=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952738098
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITALMEDRX
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2013
-----------------------------------------------------
Last Update Date | 10/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 235 E MORRIS BLVD
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37813-2342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-614-0688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 235 E MORRIS BLVD
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37813-2342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-614-0688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GERALD STEPHEN LEMARR
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 888-614-0688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 5043
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------