Provider Demographics
NPI:1245228824
Name:MEDIC PHARMACY OF BRYANT, INC.
Entity Type:Organization
Organization Name:MEDIC PHARMACY OF BRYANT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-847-3596
Mailing Address - Street 1:306 N REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-3440
Mailing Address - Country:US
Mailing Address - Phone:501-847-3596
Mailing Address - Fax:501-847-9020
Practice Address - Street 1:306 N REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-3440
Practice Address - Country:US
Practice Address - Phone:501-847-3596
Practice Address - Fax:501-847-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-08
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR01240333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0401240OtherNABP
030000679OtherMEDCO HEALTH
AR100509407Medicaid