1184635765 NPI number — ARCARE

Table of content: (NPI 1184635765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184635765 NPI number — ARCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARCARE
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:
ARCARE PHARMACY 11
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:
1184635765
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 S. 2ND STREET, PO BOX 497
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72006-0497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-347-2534
Provider Business Mailing Address Fax Number:
501-842-9335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 STUTTGART HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLAND
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72046-1557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-842-2575
Provider Business Practice Location Address Fax Number:
501-842-9335
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEEHN
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFA
Authorized Official Telephone Number:
870-347-3342

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  AR17786 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 161159407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1989772 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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