Provider Demographics
NPI:1881108454
Name:VITALE RX LLC
Entity type:Organization
Organization Name:VITALE RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOTEIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-977-0038
Mailing Address - Street 1:14635 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2483
Mailing Address - Country:US
Mailing Address - Phone:734-324-1094
Mailing Address - Fax:734-324-1093
Practice Address - Street 1:14635 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2483
Practice Address - Country:US
Practice Address - Phone:734-324-1094
Practice Address - Fax:734-324-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-18
Last Update Date:2017-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy