Provider Demographics
NPI:1407355480
Name:VITAL RX
Entity Type:Organization
Organization Name:VITAL RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEBOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-209-5540
Mailing Address - Street 1:237 CAHABA VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1146
Mailing Address - Country:US
Mailing Address - Phone:866-209-5540
Mailing Address - Fax:
Practice Address - Street 1:237 CAHABA VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1146
Practice Address - Country:US
Practice Address - Phone:866-209-5540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy