| Vitalab Pharmacy Inc | |
|
4045 E Bell Rd Ste 157 Suite 157 Phoenix AZ 85032 | |
| (602) 346-0204 | |
| (877) 637-6691 |
| Full Name | Vitalab Pharmacy Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4045 E Bell Rd Ste 157, Phoenix, Arizona |
| Authorized Official Name and Position | Paul Vasiliauskas (SR.V.P. BUSINESS DEVELOPMENT) |
| Authorized Official Contact | 6029716950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitalab Pharmacy Inc 4045 E Bell Rd Ste 157 Suite 157 Phoenix AZ 85032-2240 Ph: (602) 346-0204 | Vitalab Pharmacy Inc 4045 E Bell Rd Ste 157 Suite 157 Phoenix AZ 85032 Ph: (602) 346-0204 |
| NPI Number | 1073982120 |
|---|---|
| Provider Enumeration Date | 09/18/2015 |
| Last Update Date | 04/28/2022 |
| Medicare PECOS PAC ID | 9032352042 |
|---|---|
| Medicare Enrollment ID | O20160224001021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073982120 | NPI | - | NPPES |
| 302331 | Medicaid | AZ | |
| 127832 | Medicaid | AZ |
| Provider Name | Ashvin K Shah |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1013015270 PECOS PAC ID: 3870559271 Enrollment ID: I20041207001283 |
| Provider Name | Kenneth O Anaeme |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386618650 PECOS PAC ID: 5799711107 Enrollment ID: I20050715000920 |
| Provider Name | Timothy J Burns |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245277243 PECOS PAC ID: 2365457330 Enrollment ID: I20060308000426 |
| Provider Name | Kiara Shanee Deem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447627856 PECOS PAC ID: 3971806480 Enrollment ID: I20160115001720 |
| Provider Name | Adam S Leon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205361078 PECOS PAC ID: 8426314311 Enrollment ID: I20171109000690 |
| Provider Name | Somaly Sith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033618293 PECOS PAC ID: 5799103529 Enrollment ID: I20200915002463 |
| Provider Name | Angela Kristin Lillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811206949 PECOS PAC ID: 6608286323 Enrollment ID: I20201109003074 |
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