New Vitalis, LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

P07786 Issued in KY

Legal business name

NEW VITALIS, LLC

Practice address

4139 Cadillac CT
Suite 201
Louisville, KY 40213-1578

Phone

(502) 425-0500

NPI assigned

Sep 27, 2016

Organization subpart

Yes

Parent organization

BSM HOLDINGS, LLCAs reported in NPPES

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

Authorized official

Name

Mr. Ted Ennenbach

Title

Ceo

Phone

(502) 425-0500

Specialties & licenses 1

Addresses

Part of

Body Shape Medical

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Jesse Kellihan, PHARM.D.

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Louisville, KY
  • NPI 1629528641
  NPD (past)

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

{
    "created_epoch": "1474934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474934400000",
    "number": "1801345111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9600 BROWNSBORO RD",
            "address_2": "SUITE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402413901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4139 CADILLAC CT",
            "address_2": "SUITE 201",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402131578",
            "telephone_number": "502-425-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW VITALIS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BSM HOLDINGS, LLC",
        "enumeration_date": "2016-09-27",
        "last_updated": "2016-09-27",
        "status": "A",
        "authorized_official_last_name": "ENNENBACH",
        "authorized_official_first_name": "TED",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "502-425-0500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "KY",
            "license": "P07786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Compounding Pharmacy in Louisville, KY
• Providers in Louisville, KY by specialty
• Compounding Pharmacy in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; 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.