Provider Demographics
NPI:1437225398
Name:NEWCOMBS HEALTHMART
Entity Type:Organization
Organization Name:NEWCOMBS HEALTHMART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAPERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:870-563-5618
Mailing Address - Street 1:100 E HALE
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72370
Mailing Address - Country:US
Mailing Address - Phone:870-563-2618
Mailing Address - Fax:870-563-2036
Practice Address - Street 1:100 E HALE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370
Practice Address - Country:US
Practice Address - Phone:870-563-2618
Practice Address - Fax:870-563-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR05375333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100403407Medicaid
AR100403407Medicaid