Provider Demographics
NPI:1598167280
Name:PETER CASEY ENTERPRISES LLC
Entity Type:Organization
Organization Name:PETER CASEY ENTERPRISES LLC
Other - Org Name:BRIAN'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOESY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-392-6412
Mailing Address - Street 1:4201 E KIEHL AVE
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-3541
Mailing Address - Country:US
Mailing Address - Phone:501-392-6412
Mailing Address - Fax:501-819-0081
Practice Address - Street 1:4201 E KIEHL AVE
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-3541
Practice Address - Country:US
Practice Address - Phone:501-392-6412
Practice Address - Fax:501-819-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR206317407Medicaid