MEDICARE: VITAL RX OF TENNESSEE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3336M0002X	Mail Order Pharmacy
2	3336S0011X	Specialty Pharmacy
3	3336H0001X	Home Infusion Therapy Pharmacy

General Provider Information

NPI Number	:	1861991846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL RX OF TENNESSEE LLC

Provider Business Mailing Address
First Line	:	150 COLLINS ST
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-3814
Country	:	US
Telephone Number	:	866-341-0200
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 COLLINS ST
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-3814
Country	:	US
Telephone Number	:	866-341-0200
Fax Number	:

Authorized Official
Title or Position	:	DIR OF PHARMACY/MANAGING MEMBER
Name	:	AMI JONES WITTBER
Credential	:
Telephone Number	:	901-443-2500

Provider Enumeration Date	:	02/06/2018
Last Update Date	:	02/06/2018

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