1457423238 NPI number — PHC PHARMACIES INC

Table of content: (NPI 1457423238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457423238 NPI number — PHC PHARMACIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHC PHARMACIES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDICINE SHOPPE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457423238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2080 HARRISON ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
BATESVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72501-7413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2080 HARRISON ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BATESVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72501-7413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-793-2161
Provider Business Practice Location Address Fax Number:
870-793-4569
Provider Enumeration Date:
11/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SKOKOS
Authorized Official First Name:
C
Authorized Official Middle Name:
KEMP
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
870-793-2161

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 0419108 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 139395407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0419108 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".