Provider Demographics
NPI:1093863037
Name:REDFIELD PHARMACY MANGEMENT LLC
Entity Type:Organization
Organization Name:REDFIELD PHARMACY MANGEMENT LLC
Other - Org Name:REDFIELD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-681-5740
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72132-0326
Mailing Address - Country:US
Mailing Address - Phone:501-397-5400
Mailing Address - Fax:501-397-2218
Practice Address - Street 1:1017 SHERIDAN ROAD #3
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:AR
Practice Address - Zip Code:72132-0326
Practice Address - Country:US
Practice Address - Phone:501-397-5400
Practice Address - Fax:501-397-2218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR190453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1988040OtherPK
AR161831407Medicaid