Provider Demographics
NPI:1073794020
Name:ELAINE PHARMACY
Entity Type:Organization
Organization Name:ELAINE PHARMACY
Other - Org Name:SCHUBACH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-572-7770
Mailing Address - Street 1:806 N SEBASTIAN
Mailing Address - Street 2:
Mailing Address - City:WEST HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72390-1821
Mailing Address - Country:US
Mailing Address - Phone:870-572-7770
Mailing Address - Fax:870-572-7666
Practice Address - Street 1:806 N SEBASTIAN
Practice Address - Street 2:
Practice Address - City:WEST HELENA
Practice Address - State:AR
Practice Address - Zip Code:72390-1821
Practice Address - Country:US
Practice Address - Phone:870-572-7770
Practice Address - Fax:870-572-7666
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELAINE PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4553970001Medicare NSC