Provider Demographics
NPI:1447590146
Name:WHITEHALL PHARMACY LLC
Entity Type:Organization
Organization Name:WHITEHALL PHARMACY LLC
Other - Org Name:DOCTOR'S ORDERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:STICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-442-4657
Mailing Address - Street 1:2302 W 28TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-5081
Mailing Address - Country:US
Mailing Address - Phone:870-671-4914
Mailing Address - Fax:870-671-4917
Practice Address - Street 1:2302 W 28TH AVE STE B
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5081
Practice Address - Country:US
Practice Address - Phone:870-671-4914
Practice Address - Fax:870-671-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR207083336C0003X, 3336C0003X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR197607407Medicaid
2138758OtherPK