Provider Demographics
NPI:1093118945
Name:IVY FAMILY PHARMACY,INC
Entity Type:Organization
Organization Name:IVY FAMILY PHARMACY,INC
Other - Org Name:FAMILY DISCO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:IVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-206-7301
Mailing Address - Street 1:120 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-3810
Mailing Address - Country:US
Mailing Address - Phone:501-362-5853
Mailing Address - Fax:501-362-5854
Practice Address - Street 1:120 S 4TH ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-3810
Practice Address - Country:US
Practice Address - Phone:501-362-5853
Practice Address - Fax:501-362-5854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR070383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148245OtherPK