Provider Demographics
NPI:1356608772
Name:VITAMEDMD LLC
Entity type:Organization
Organization Name:VITAMEDMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF STRATEGY OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-961-1921
Mailing Address - Street 1:951 BROKEN SOUND PKWY NW STE 320
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3531
Mailing Address - Country:US
Mailing Address - Phone:561-961-1921
Mailing Address - Fax:561-431-3389
Practice Address - Street 1:951 BROKEN SOUND PKWY NW STE 320
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-3531
Practice Address - Country:US
Practice Address - Phone:561-961-1921
Practice Address - Fax:561-431-3389
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERAPEUTICSMD INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1376866332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site