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General NPI Number Information
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NPI Number | 1972616308
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Entity Type | Organization
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Legal Business Name | REISZ PHARMACEUTICALS VITAL CARE, INC.
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2315 MAYFAIR DR MAYFAIR SQUARE PROFESSIONAL BUILDING
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City | OWENSBORO
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State | KY
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Zip | 42301-4557
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Country | US
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Telephone | 270-683-7379
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5047
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City | MERIDIAN
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State | MS
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Zip | 39302-5047
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | E REISZ
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Credential |
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Telephone | 270-683-7379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | P02023
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License Number State | KY
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