| Name: | Vital Rx, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 22 Apr 2016 (9 years ago) |
| Entity Number: | 000-360-644 |
| Register Number: | 000360644 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 2090 COLUMBIANA ROAD SUITE 2000BIRMINGHAM, AL 35216 |
| Registered Office Street Address ZIP Code: | 35216 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710486410 | 2018-02-08 | 2018-02-08 | 237 CAHABA VALLEY PKWY, PELHAM, AL, 351241146, US | 237 CAHABA VALLEY PKWY, PELHAM, AL, 351241146, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 866-209-5540 |
| Fax | 8008784160 |
Authorized person
| Name | JASON FLEBOTTE |
| Role | PHARMACIST IN CHARGE |
| Phone | 8662095540 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336H0001X - Home Infusion Therapy Pharmacy |
| License Number | 114629 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 3336M0002X - Mail Order Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336S0011X - Specialty Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 189993 |
| State | AL |
| Issuer | PK |
| Number | 2175777 |
| Name | Role | Address |
|---|---|---|
| HASTY, WILLIAM D JR | Agent | 2090 COLUMBIANA ROAD STE 2000BIRMINGHAM, AL 35216 |
| Name | Role | Address |
|---|---|---|
| HASTY, WILLIAM D JR | Organizer | 2090 COLUMBIANA ROAD STE 2000BIRMINGHAM, AL 35216 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
