Provider Demographics
NPI:1215557905
Name:MEDMAN23, INC
Entity Type:Organization
Organization Name:MEDMAN23, INC
Other - Org Name:MEDICINE MAN PHARMACY SPRINGHILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-940-7517
Mailing Address - Street 1:3201 SPRINGHILL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2910
Mailing Address - Country:US
Mailing Address - Phone:501-476-3514
Mailing Address - Fax:501-235-3964
Practice Address - Street 1:3201 SPRINGHILL DR STE 110
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2910
Practice Address - Country:US
Practice Address - Phone:501-476-3514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR247389407Medicaid