Provider Demographics
NPI:1598751984
Name:GARDEN OAKS PHARMACY INC
Entity Type:Organization
Organization Name:GARDEN OAKS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:CYPHERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:870-836-8176
Mailing Address - Street 1:200 GARDEN OAKS DR SW
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-3733
Mailing Address - Country:US
Mailing Address - Phone:870-836-8176
Mailing Address - Fax:870-836-9122
Practice Address - Street 1:200 GARDEN OAKS DR SW
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-3733
Practice Address - Country:US
Practice Address - Phone:870-836-8176
Practice Address - Fax:870-836-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0418738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR126328407Medicaid
AR1235960001Medicare NSC