Healthcare Provider Details

I. General information

NPI: 1487410247
Provider Name (Legal Business Name): MED VAULT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 ALLATOONA GTWY
ACWORTH GA
30101-4906
US

IV. Provider business mailing address

4621 WATERS EDGE LN NW
ACWORTH GA
30101-6238
US

V. Phone/Fax

Practice location:
  • Phone: 470-377-4462
  • Fax: 678-744-2849
Mailing address:
  • Phone: 470-377-4462
  • Fax: 678-744-2849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHINYERE NWEGBO
Title or Position: CEO/PIC
Credential: PHARMD
Phone: 470-377-4462