Provider Demographics
NPI:1528617099
Name:VITACARE PHARMACY INC.
Entity type:Organization
Organization Name:VITACARE PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ASSAN
Authorized Official - Last Name:BANAHENE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:917-705-6825
Mailing Address - Street 1:10501 BLACKLICK EASTERN RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7878
Mailing Address - Country:US
Mailing Address - Phone:614-333-0168
Mailing Address - Fax:
Practice Address - Street 1:10501 BLACKLICK EASTERN RD STE 800-1
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7871
Practice Address - Country:US
Practice Address - Phone:614-333-0168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-08
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy