Provider Demographics
NPI:1467506923
Name:PERKINS PHARMACIES INC
Entity Type:Organization
Organization Name:PERKINS PHARMACIES INC
Other - Org Name:MEDICINE MAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-758-7581
Mailing Address - Street 1:2520 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NO LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114
Mailing Address - Country:US
Mailing Address - Phone:501-758-7581
Mailing Address - Fax:501-758-8503
Practice Address - Street 1:2520 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:NO LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114
Practice Address - Country:US
Practice Address - Phone:501-758-7581
Practice Address - Fax:501-758-8503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR18966333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129412716OtherMEDICAID DME
AR127495407Medicaid
AR10547Medicare PIN
AR127495407Medicaid