Provider Demographics
NPI:1487118147
Name:VITARB CORPORATION
Entity type:Organization
Organization Name:VITARB CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT (PHARMACIST IN CHARGE)
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:T
Authorized Official - Last Name:OLOYEDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:432-296-9080
Mailing Address - Street 1:5614 W GRAND PKWY S STE 102-133
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5820
Mailing Address - Country:US
Mailing Address - Phone:432-296-9080
Mailing Address - Fax:
Practice Address - Street 1:6186B WILCREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-1450
Practice Address - Country:US
Practice Address - Phone:281-406-8790
Practice Address - Fax:281-258-4838
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VITARB CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-28
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150026Medicaid