Provider Demographics
NPI:1205329943
Name:DOCTOR'S PHARMACY-VITAL CARE, INC.
Entity type:Organization
Organization Name:DOCTOR'S PHARMACY-VITAL CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position: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 1:116 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:GA
Practice Address - Zip Code:31063-1903
Practice Address - Country:US
Practice Address - Phone:478-472-2040
Practice Address - Fax:478-472-9822
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTOR'S PHARMACY-VITAL CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-07
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003215966AMedicaid