Provider Demographics
NPI:1386492650
Name:VITAL HEALTH PHARMACY LLC
Entity type:Organization
Organization Name:VITAL HEALTH PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HOUSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:519-919-1234
Mailing Address - Street 1:17950 WOODWARD AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2260
Mailing Address - Country:US
Mailing Address - Phone:519-919-1234
Mailing Address - Fax:
Practice Address - Street 1:17950 WOODWARD AVE STE 2
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-2260
Practice Address - Country:US
Practice Address - Phone:519-919-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy