Vitasource Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

VITASOURCE PHARMACY LLC

Doing business as

Vitasource Pharmacy

Practice address

3806 Avenue I Ste 28
Rosenberg, TX 77471-3951

Phone

(844) 744-0101

Fax

(844) 744-0101

NPI assigned

May 26, 2021

Last updated

May 26, 2021By 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

Mr. Shailendra GuptaNPI 1942968201

Title

Officer

Phone

(844) 843-0101

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• VITASOURCE PHARMACY Doing business as

Tax ID family

Vitasource Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Vitasource Pharmacy LLC

  • Long Term Care Pharmacy
  • Rosenberg, TX
  • NPI 1326905845
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shailendra Ambeykumar Gupta

  • Pharmacist
  • Rosenberg, TX
  • NPI 1942968201
  NPD Authorized official

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

{
    "created_epoch": "1621987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621987200000",
    "number": "1871168229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3806 AVENUE I STE 28",
            "city": "ROSENBERG",
            "state": "TX",
            "postal_code": "774713951",
            "telephone_number": "844-744-0101",
            "fax_number": "844-744-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3806 AVENUE I STE 28",
            "city": "ROSENBERG",
            "state": "TX",
            "postal_code": "774713951",
            "telephone_number": "844-744-0101",
            "fax_number": "844-744-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITASOURCE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-26",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "SHAILENDRA",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "844-843-0101",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS STATE BOARD OF PHARMACY",
            "identifier": "33786",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VITASOURCE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joycelyn Villegas
• Alix Vincent, RPH
• Lyla Nicole Vinklarek, M.A.
• Visionworks, Inc. (Visionworks)
• Vitasource Pharmacy LLC
• VM Medical Solutions
• Monique Quynh Tien Vu, DDS
• Walgreen Co (Walgreens #02958)
• Walgreen Co (Walgreens #11909)
• Andria Walker, FNP-C

• Pharmacy in Rosenberg, TX
• Providers in Rosenberg, TX by specialty
• Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; 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.