Healthcare Provider Details

I. General information

NPI: 1730594870
Provider Name (Legal Business Name): CARMICHAELS OF COVINGTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 05/04/2023
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9148 HIGHWAY 278 NE STE D
COVINGTON GA
30014-7032
US

IV. Provider business mailing address

PO BOX 965
MONROE GA
30655-0965
US

V. Phone/Fax

Practice location:
  • Phone: 678-712-4570
  • Fax: 678-712-4558
Mailing address:
  • Phone: 770-267-2559
  • Fax: 770-267-6138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE010037
License Number StateGA

VIII. Authorized Official

Name: RAYMOND HICKMAN
Title or Position: OWNER
Credential:
Phone: 770-317-2850