MEDICARE: YES VITAL RX INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	054019563	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2157271	OTHER		PK

General Provider Information

NPI Number	:	1104129394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YES VITAL RX INC

Provider Business Mailing Address
First Line	:	1817 SHERIDAN RD
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-2235
Country	:	US
Telephone Number	:	224-656-5797
Fax Number	:	224-656-5704

Provider Business Practice Location Address
First Line	:	1817 SHERIDAN RD
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-2235
Country	:	US
Telephone Number	:	224-656-5797
Fax Number	:	224-656-5704

Authorized Official
Title or Position	:	OWNER
Name	:	NISHA JANI
Credential	:
Telephone Number	:	224-656-5797

Provider Enumeration Date	:	12/10/2010
Last Update Date	:	01/07/2025

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Directions to “YES VITAL RX INC ” Practice Location

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