Provider Demographics
NPI:1376825406
Name:FAITH & HOPE, INC
Entity Type:Organization
Organization Name:FAITH & HOPE, INC
Other - Org Name:MEDI SHOP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASUERE
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:479-394-3254
Mailing Address - Street 1:204 HIGHWAY 71 S
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-4638
Mailing Address - Country:US
Mailing Address - Phone:479-394-3287
Mailing Address - Fax:479-394-0235
Practice Address - Street 1:204 HIGHWAY 71 S
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4638
Practice Address - Country:US
Practice Address - Phone:479-394-3287
Practice Address - Fax:479-394-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR20383332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR156261716Medicaid
AR156261716Medicaid