Provider Demographics
NPI:1508972167
Name:MEDIC PHARMACY INC
Entity Type:Organization
Organization Name:MEDIC PHARMACY INC
Other - Org Name:MEDIC PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOUX
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:501-664-3907
Mailing Address - Street 1:5901 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1608
Mailing Address - Country:US
Mailing Address - Phone:501-664-3907
Mailing Address - Fax:501-664-4491
Practice Address - Street 1:5901 W 12TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1608
Practice Address - Country:US
Practice Address - Phone:501-664-3907
Practice Address - Fax:501-664-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR200273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0400919OtherNABP
AR0542540001OtherMEDICARE PTAN
AR100020407Medicaid