=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902843717
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEMACARE PLUS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2006
-----------------------------------------------------
Last Update Date | 10/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8909 RAND AVE STE B
-----------------------------------------------------
City | DAPHNE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36526-9126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-621-8499
-----------------------------------------------------
Fax | 251-621-3950
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8909 RAND AVE STE B
-----------------------------------------------------
City | DAPHNE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36526-9126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-621-8499
-----------------------------------------------------
Fax | 251-621-3950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DARLA K DIXON
-----------------------------------------------------
Credential | RN, BSN
-----------------------------------------------------
Telephone | 251-463-2191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336H0001X
-----------------------------------------------------
Taxonomy Name | Home Infusion Therapy Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 112808
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------