Provider Demographics
NPI:1376615971
Name:PHC PHARMACIES INC
Entity Type:Organization
Organization Name:PHC PHARMACIES INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:KEMP
Authorized Official - Last Name:SKOKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-984-6101
Mailing Address - Street 1:PO BOX 8521
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71910-8521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4545 N HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-9600
Practice Address - Country:US
Practice Address - Phone:501-984-6101
Practice Address - Fax:501-984-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AR04185503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0418550OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AR139604407Medicaid
AR139604407Medicaid
AR139604407Medicaid
0418550OtherOTHER ID NUMBER-COMMERCIAL NUMBER