Provider Demographics
NPI:1992183495
Name:VITAL RX LLC
Entity Type:Organization
Organization Name:VITAL RX LLC
Other - Org Name:ALLIED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HETALBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-668-7022
Mailing Address - Street 1:15200 SHADY GROVE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-527-0370
Mailing Address - Fax:301-527-0372
Practice Address - Street 1:15200 SHADY GROVE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-527-0370
Practice Address - Fax:301-527-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD659825100Medicaid