Provider Demographics
NPI:1629078605
Name:LEMONS PRESCRIPTION SHOP LLC
Entity Type:Organization
Organization Name:LEMONS PRESCRIPTION SHOP LLC
Other - Org Name:LEMONS PRESCRIPTION SHOP LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-354-3318
Mailing Address - Street 1:1713 E HARDING ST
Mailing Address - Street 2:PO BOX 709
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-4507
Mailing Address - Country:US
Mailing Address - Phone:501-354-3318
Mailing Address - Fax:501-354-0649
Practice Address - Street 1:1713 E HARDING ST
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-4507
Practice Address - Country:US
Practice Address - Phone:501-354-3318
Practice Address - Fax:501-354-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR048543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136108OtherPK
AR193292407Medicaid