# CARMICHAELS VITAL CARE PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Carmichael's Vital Care Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366675399
- **Authorized official:** WANDA HICKMAN (OWNER)
- **Authorized official phone:** (770) 267-2559

## Contact information

- **Practice address:** 150-D MLK JR. BLVD, MONROE, GA 30655
- **Practice address phone:** (770) 266-2937
- **Practice address fax:** (770) 207-5886
- **Mailing address:** 150-D MLK JR. BLVD, MONROE, GA 30655
- **Mailing address phone:** (770) 266-2937
- **Mailing address fax:** (770) 207-5886

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251F00000X | Home Infusion Agency | — | NULL | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336H0001X | Home Infusion Therapy Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 000045 | GA | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 08/25/2009
- **Last updated:** 05/15/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2121867 | PK | — |