Provider Demographics
NPI:1467214379
Name:VITALDRIP INFUSION PHARMACY
Entity Type:Organization
Organization Name:VITALDRIP INFUSION PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOUSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABKHEZR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-291-0954
Mailing Address - Street 1:6220 WESTPARK DR STE 111
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7413
Mailing Address - Country:US
Mailing Address - Phone:713-497-5510
Mailing Address - Fax:
Practice Address - Street 1:6220 WESTPARK DR STE 111
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7413
Practice Address - Country:US
Practice Address - Phone:713-497-5510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy