Provider Demographics
NPI:1477556926
Name:DEBBIES FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:DEBBIES FAMILY PHARMACY INC
Other - Org Name:DEBBIES FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MIZE
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:479-271-6300
Mailing Address - Street 1:5403 W PINNACLE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8118
Mailing Address - Country:US
Mailing Address - Phone:479-271-6300
Mailing Address - Fax:479-271-6305
Practice Address - Street 1:5403 W PINNACLE POINTE DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8118
Practice Address - Country:US
Practice Address - Phone:479-271-6300
Practice Address - Fax:479-271-6305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-28
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
ARAR202043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1989295OtherPK
AR139264407Medicaid
AR139264407Medicaid