MEDICARE: VITALDRIP INFUSION, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251F00000X	Home Infusion Agency
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy
4	3336C0004X	Compounding Pharmacy
5	3336S0011X	Specialty Pharmacy
6	3336H0001X	Home Infusion Therapy Pharmacy

General Provider Information

NPI Number	:	1467214379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALDRIP INFUSION, LLC

Provider Business Mailing Address
First Line	:	6220 WESTPARK DR STE 111
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-7413
Country	:	US
Telephone Number	:	713-497-5510
Fax Number	:

Provider Business Practice Location Address
First Line	:	6220 WESTPARK DR STE 111
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-7413
Country	:	US
Telephone Number	:	713-497-5510
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	MOUSA ABKHEZR
Credential	:
Telephone Number	:	713-497-5510

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	04/29/2024

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