Healthcare Provider Details

I. General information

NPI: 1366675399
Provider Name (Legal Business Name): CARMICHAELS VITAL CARE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150-D MLK JR. BLVD
MONROE GA
30655
US

IV. Provider business mailing address

150-D MLK JR. BLVD
MONROE GA
30655
US

V. Phone/Fax

Practice location:
  • Phone: 770-266-2937
  • Fax: 770-207-5886
Mailing address:
  • Phone: 770-266-2937
  • Fax: 770-207-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: WANDA HICKMAN
Title or Position: OWNER
Credential:
Phone: 770-267-2559