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Organization
VITASOURCE PHARMACY LLC
Active
Organization
VITASOURCE PHARMACY LLC
Active
Other names
VITASOURCE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAILENDRA GUPTA (OFFICER)
(844) 843-0101
Entity
Organization
Contact information
Practice address
3806 AVENUE I STE 28, ROSENBERG, TX 77471-3951
(844) 744-0101
(844) 744-0101
Mailing address
3806 AVENUE I STE 28, ROSENBERG, TX 77471-3951
(844) 744-0101
(844) 744-0101
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33786
TEXAS STATE BOARD OF PHARMACY
TX
Enumeration date
05/26/2021
Last updated
05/26/2021
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