Provider Demographics
NPI:1417432170
Name:VITA PHARMACY LLC
Entity Type:Organization
Organization Name:VITA PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-363-3106
Mailing Address - Street 1:2950 THOUSAND OAKS DR STE 25
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3347
Mailing Address - Country:US
Mailing Address - Phone:210-424-0025
Mailing Address - Fax:210-424-0026
Practice Address - Street 1:2950 THOUSAND OAKS DR STE 25
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3347
Practice Address - Country:US
Practice Address - Phone:210-424-0025
Practice Address - Fax:210-424-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy