Provider Demographics
NPI:1083608319
Name:MEDIC PHARMACY INC OF EL DORADO
Entity Type:Organization
Organization Name:MEDIC PHARMACY INC OF EL DORADO
Other - Org Name:MEDIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HANRY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:870-862-4931
Mailing Address - Street 1:347 W OAK ST SUITE A
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4564
Mailing Address - Country:US
Mailing Address - Phone:870-862-4931
Mailing Address - Fax:870-862-6659
Practice Address - Street 1:347 W OAK STREET
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4521
Practice Address - Country:US
Practice Address - Phone:870-862-4931
Practice Address - Fax:870-862-6659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR14540183500000X
332B00000X, 3336C0003X, 3336C0004X
ARAR145403336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100136407Medicaid