Provider Demographics
NPI:1598774705
Name:DOCTOR'S PHARMACY-VITAL CARE, INC.
Entity Type:Organization
Organization Name:DOCTOR'S PHARMACY-VITAL CARE, INC.
Other - Org Name:DOCTORS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-928-9010
Mailing Address - Street 1:611 E LAMAR ST STE B
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3744
Mailing Address - Country:US
Mailing Address - Phone:229-928-9010
Mailing Address - Fax:229-928-4477
Practice Address - Street 1:611 E LAMAR ST STE B
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3744
Practice Address - Country:US
Practice Address - Phone:229-928-9010
Practice Address - Fax:229-928-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X, 3336C0004X, 3336L0003X
GAPHHH0000523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA327980256AMedicaid
GA327980256AMedicaid
GA327980256AMedicaid