Organization
VITA PHARMACY LLC
Active
Other names
Vita Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
IGOR CHERNYAKOVSKY (MANAGING MEMEBER)
(410) 325-1641
Entity
Organization
Contact information
Practice address
5617 BELAIR RD, BALTIMORE, MD 21206-3619
(410) 325-1641
(410) 325-1642
Mailing address
5617 BELAIR RD, BALTIMORE, MD 21206-3619
(410) 325-1641
(410) 325-1642
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PW0319
MD
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134207
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/18/2008
Last updated
04/06/2010
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