Provider Demographics
NPI:1063059723
Name:VITAL CHEMIST INC.
Entity type:Organization
Organization Name:VITAL CHEMIST INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HANY
Authorized Official - Middle Name:FIKRY
Authorized Official - Last Name:BORHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-758-5557
Mailing Address - Street 1:6404 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3904
Mailing Address - Country:US
Mailing Address - Phone:718-758-5557
Mailing Address - Fax:
Practice Address - Street 1:6404 20TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3904
Practice Address - Country:US
Practice Address - Phone:718-758-5557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy