Vital Life Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH28149 Issued in FL

Legal business name

VITAL LIFE PHARMACY

Practice address

6063 SW 18TH St
Bay 112
Boca Raton, FL 33433-7118

Phone

(561) 245-7082

NPI assigned

May 15, 2014

Last updated

May 15, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicole Balarezo, PHARMD

Title

Owner

Phone

(954) 871-7633

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400112000000",
    "number": "1699186353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6063 SW 18TH ST",
            "address_2": "BAY 112",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334337118",
            "telephone_number": "561-245-7082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6063 SW 18TH ST",
            "address_2": "BAY 112",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334337118",
            "telephone_number": "561-245-7082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL LIFE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-15",
        "last_updated": "2014-05-15",
        "status": "A",
        "authorized_official_last_name": "BALAREZO",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-871-7633",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH28149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vitacare Prescription Services, Inc
• Vital Bridge Care Management LLC
• Vital Care of America,Inc (vital care)
• Vital Elements Health Ctr Inc
• Vital Image Health, LLC (Vital Image Med Spa and Anti-Aging)
• Vital Medical Inc.
• Marielle Francesca Vitale, AA
• Vitamedmd LLC
• Kornelia Anna Vitez, A.P., DIPL.OM
• Angela Teresa Vittori, MD

• Community/Retail Pharmacy in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.