14D2199663 CLIA NUMBER - VITAL SPECIALTY PHARMACY HEENA VITAL RX, INC D/B/A

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Laboratory Demographics

CLIA Number: 14D2199663

Facility Name: VITAL SPECIALTY PHARMACY HEENA VITAL RX, INC D/B/A

Facility Address:
1525 E 55TH ST, STE 103
CHICAGO, IL
ZIP 60615
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Facility Phone Number: 708 257-8333

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1427698349

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	14D2199663
LAB Type	Pharmacy
Facility Name	VITAL SPECIALTY PHARMACY HEENA VITAL RX, INC D/B/A
Street	1525 E 55TH ST, STE 103
City	CHICAGO
State	IL
ZIP	60615
Phone	708 257-8333
CertificateType	4
CertificateEffectiveDate	11/10/2022
CertificateExpirationDate	11/9/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024