Vital RX of Louisiana LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY007506-IR Issued in LA

Legal business name

VITAL RX OF LOUISIANA LLC

Practice address

6200 Leslie Lane
Lake Charles, LA 70615-4772

Phone

(877) 264-8060

Fax

(888) 811-4564

NPI assigned

Aug 1, 2017

Organization subpart

No

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

Authorized official

Name

Joseph Tate

Title

Director

Phone

(337) 304-9342

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• VitalRx of Louisiana Doing business as

Locations

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

{
    "created_epoch": "1501545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645488000000",
    "number": "1780108704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 LESLIE LANE",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706154772",
            "telephone_number": "877-264-8060",
            "fax_number": "888-811-4564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 LESLIE LANE",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706154772",
            "telephone_number": "877-264-8060",
            "fax_number": "888-811-4564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL RX OF LOUISIANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-01",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "TATE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "337-304-9342"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "PHY007506-IR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2170664",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2205421",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VitalRx of Louisiana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hortensia Maria Vincent, LCSW
• Mishayla Vincent, LPN
• Myra S Vincent
• Alexandria Viola, MA
• Visionworks Inc
• Vital RX of Louisiana LLC
• Amanda Evette Vital, BGS, M.A.T., ED.S.
• Pamela E. Vital
• Robert E Voight, DPT
• Volunteers of America Greater Baton Rouge

• Community/Retail Pharmacy in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Community/Retail Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; 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.