Healthcare Provider Details

I. General information

NPI: 1619807617
Provider Name (Legal Business Name): CARLEA VICKERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N HERVEY ST
HOPE AR
71801-8418
US

IV. Provider business mailing address

927 HEMPSTEAD 9
HOPE AR
71801-9349
US

V. Phone/Fax

Practice location:
  • Phone: 870-777-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD17681
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: