Provider Demographics
NPI:1164405858
Name:NATIONAL FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:NATIONAL FAMILY PHARMACY INC
Other - Org Name:NATIONAL FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:FENWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-783-6135
Mailing Address - Street 1:1615 DODSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-5129
Mailing Address - Country:US
Mailing Address - Phone:479-783-6135
Mailing Address - Fax:479-785-2922
Practice Address - Street 1:1615 DODSON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5129
Practice Address - Country:US
Practice Address - Phone:479-783-6135
Practice Address - Fax:479-785-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR029633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100031407Medicaid
1992958OtherPK
0683740001Medicare NSC