1801808837 NPI number — HEALTH DEPOT PHARMACIES, LLC

Table of content: (NPI 1801808837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801808837 NPI number — HEALTH DEPOT PHARMACIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH DEPOT PHARMACIES, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1801808837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7700 HWY 271 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72908-8028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-646-7875
Provider Business Mailing Address Fax Number:
479-646-7875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1530 W CENTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-996-9898
Provider Business Practice Location Address Fax Number:
479-996-1342
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
HENRY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
479-646-7875

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: AR20188 , 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: 1002450800 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1989351 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 221378407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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