Provider Demographics
NPI:1669487286
Name:MILITARY APOTHECARY LP
Entity Type:Organization
Organization Name:MILITARY APOTHECARY LP
Other - Org Name:VITAL LIFE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:MILAN
Authorized Official - Last Name:CHHADUA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:214-422-2598
Mailing Address - Street 1:PO BOX 2735
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0051
Mailing Address - Country:US
Mailing Address - Phone:469-294-2001
Mailing Address - Fax:469-888-8448
Practice Address - Street 1:418 N LOOP 1604 W STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1456
Practice Address - Country:US
Practice Address - Phone:210-802-0553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X, 333600000X, 3336C0002X, 3336L0003X
TX243713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4540399OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX145643Medicaid
TX32470OtherTEXAS STATE BOARD OF PHARMACY