Provider Demographics
NPI:1740426915
Name:HOME CARE MEDICAL, LLC
Entity Type:Organization
Organization Name:HOME CARE MEDICAL, LLC
Other - Org Name:HOME CARE PHARMACY VITAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-235-1468
Mailing Address - Street 1:220 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-3902
Mailing Address - Country:US
Mailing Address - Phone:405-235-1468
Mailing Address - Fax:405-235-1476
Practice Address - Street 1:220 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3902
Practice Address - Country:US
Practice Address - Phone:405-235-1468
Practice Address - Fax:405-235-1476
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME CARE MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-4589333600000X, 3336C0003X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy