Provider Demographics
NPI:1407881360
Name:AMYCO, INC
Entity Type:Organization
Organization Name:AMYCO, INC
Other - Org Name:ANDERSON'S DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KANDICE
Authorized Official - Middle Name:AMY
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:479-782-2881
Mailing Address - Street 1:700 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4738
Mailing Address - Country:US
Mailing Address - Phone:479-782-2881
Mailing Address - Fax:479-782-3974
Practice Address - Street 1:700 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4738
Practice Address - Country:US
Practice Address - Phone:479-782-2881
Practice Address - Fax:479-782-3974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49917OtherBLUE CROSS & BLUE SHIELD
AR152323716Medicaid
AR148970407Medicaid
OK100801990AMedicaid
OK100240420AMedicaid
AR152323716Medicaid