Organization
MLB PHARMACY LLC
Active
Other names
Vital Care Infusion Services
Organization subpart
No
Provider details
NPI number
Authorized official
MICAH PRATT PHARMD (OWNER)
(325) 777-1423
Entity
Organization
Contact information
Practice address
11 W BEAUREGARD AVE, SAN ANGELO, TX 76903-5832
(325) 777-1423
(325) 777-1430
Mailing address
11 W BEAUREGARD AVE, SAN ANGELO, TX 76903-5832
(806) 548-0590
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
Other
Enumeration date
09/20/2021
Last updated
11/17/2022
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