Provider Demographics
NPI:1861991846
Name:VITAL RX OF TENNESSEE LLC
Entity type:Organization
Organization Name:VITAL RX OF TENNESSEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF PHARMACY/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMI
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:WITTBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-443-2500
Mailing Address - Street 1:150 COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-3814
Mailing Address - Country:US
Mailing Address - Phone:866-341-0200
Mailing Address - Fax:
Practice Address - Street 1:150 COLLINS ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-3814
Practice Address - Country:US
Practice Address - Phone:866-341-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy