Provider Demographics
NPI:1356629919
Name:VITAHEALTH PHARMACY, INC.
Entity Type:Organization
Organization Name:VITAHEALTH PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SHERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AYOUB
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-777-8482
Mailing Address - Street 1:4116 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2968
Mailing Address - Country:US
Mailing Address - Phone:718-777-8482
Mailing Address - Fax:718-777-8489
Practice Address - Street 1:4116 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2968
Practice Address - Country:US
Practice Address - Phone:718-777-8482
Practice Address - Fax:718-777-8489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0308253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy