1598180606 NPI number — VITAL NUTRITION, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598180606 NPI number — VITAL NUTRITION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITAL NUTRITION, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598180606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2728 ARMFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBOROUGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27278-9440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-886-4140
Provider Business Mailing Address Fax Number:
919-526-7440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 IREDELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27705-4862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-886-4140
Provider Business Practice Location Address Fax Number:
919-526-7440
Provider Enumeration Date:
02/26/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ZUECH
Authorized Official First Name:
MALLORY
Authorized Official Middle Name:
Authorized Official Title or Position:
CONSULTANT DIETITIAN
Authorized Official Telephone Number:
919-886-4140

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  989672 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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