Organization
VITAL RX OF LOUISIANA LLC
Active
Other names
VitalRx of Louisiana
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH TATE (DIRECTOR)
(337) 304-9342
Entity
Organization
Contact information
Practice address
6200 LESLIE LANE, LAKE CHARLES, LA 70615-4772
(877) 264-8060
(888) 811-4564
Mailing address
6200 LESLIE LANE, LAKE CHARLES, LA 70615-4772
(877) 264-8060
(888) 811-4564
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY007506-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2170664
PK
—
05
—
2205421
—
LA
Enumeration date
08/01/2017
Last updated
02/22/2022
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