Provider Demographics
NPI:1104129394
Name:YES VITAL RX INC
Entity type:Organization
Organization Name:YES VITAL RX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-656-5797
Mailing Address - Street 1:1817 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-2235
Mailing Address - Country:US
Mailing Address - Phone:224-656-5797
Mailing Address - Fax:224-656-5704
Practice Address - Street 1:1817 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-2235
Practice Address - Country:US
Practice Address - Phone:224-656-5797
Practice Address - Fax:224-656-5704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540195633336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157271OtherPK