Provider Demographics
NPI:1093905721
Name:PHARMEDIC, INC
Entity Type:Organization
Organization Name:PHARMEDIC, INC
Other - Org Name:MEDICAL ARTS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-525-3606
Mailing Address - Street 1:4425 CENTRAL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913
Mailing Address - Country:US
Mailing Address - Phone:501-525-3606
Mailing Address - Fax:501-525-0628
Practice Address - Street 1:4425 CENTRAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-525-3606
Practice Address - Fax:501-525-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZI930734156FX1800X
AR25090332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49255OtherBCBS
OHAR0734OtherEYEMED
AR0694960001Medicare NSC