Provider Demographics
NPI:1407508765
Name:PHARMACY OF SHANNON HILLS LLC
Entity Type:Organization
Organization Name:PHARMACY OF SHANNON HILLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:CALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-451-7715
Mailing Address - Street 1:13907 HIGH RD
Mailing Address - Street 2:
Mailing Address - City:MABELVALE
Mailing Address - State:AR
Mailing Address - Zip Code:72103-3212
Mailing Address - Country:US
Mailing Address - Phone:501-451-7715
Mailing Address - Fax:501-451-7761
Practice Address - Street 1:13907 HIGH RD
Practice Address - Street 2:
Practice Address - City:MABELVALE
Practice Address - State:AR
Practice Address - Zip Code:72103-3212
Practice Address - Country:US
Practice Address - Phone:501-451-7715
Practice Address - Fax:501-451-7761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy