Provider Demographics
NPI:1518576776
Name:ACHOR FAMILY PHARMACY, LLC
Entity Type:Organization
Organization Name:ACHOR FAMILY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-274-1130
Mailing Address - Street 1:1900 CLUB MANOR DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7443
Mailing Address - Country:US
Mailing Address - Phone:501-274-1130
Mailing Address - Fax:501-274-1131
Practice Address - Street 1:1900 CLUB MANOR DR STE 101
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-7443
Practice Address - Country:US
Practice Address - Phone:501-274-1130
Practice Address - Fax:501-274-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2023-08-21
Deactivation Date:2021-06-16
Deactivation Code:
Reactivation Date:2023-08-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR234295407Medicaid