# VITAL RX OF LOUISIANA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** VitalRx of Louisiana
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780108704
- **Authorized official:** JOSEPH TATE (DIRECTOR)
- **Authorized official phone:** (337) 304-9342

## Contact information

- **Practice address:** 6200 LESLIE LANE, LAKE CHARLES, LA 70615-4772
- **Practice address phone:** (877) 264-8060
- **Practice address fax:** (888) 811-4564
- **Mailing address:** 6200 LESLIE LANE, LAKE CHARLES, LA 70615-4772
- **Mailing address phone:** (877) 264-8060
- **Mailing address fax:** (888) 811-4564

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHY007506-IR | LA | Yes |

## Other

- **Enumeration date:** 08/01/2017
- **Last updated:** 02/22/2022