Organization
NEW VITALIS, LLC
Active
Parent organization
BSM HOLDINGS, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BSM HOLDINGS, LLC
Authorized official
MR. TED ENNENBACH (CEO)
(502) 425-0500
Entity
Organization
Contact information
Practice address
4139 CADILLAC CT, SUITE 201, LOUISVILLE, KY 40213-1578
(502) 425-0500
Mailing address
9600 BROWNSBORO RD, SUITE 200, LOUISVILLE, KY 40241-3901
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
P07786
KY
Other
Enumeration date
09/27/2016
Last updated
09/27/2016
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