Provider Demographics
NPI:1649585985
Name:CABOT PHARMACY INC
Entity Type:Organization
Organization Name:CABOT PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BLANSETT
Authorized Official - Suffix:
Authorized Official - Credentials:PD,
Authorized Official - Phone:501-941-4400
Mailing Address - Street 1:2006 S PINE ST STE F
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-8179
Mailing Address - Country:US
Mailing Address - Phone:501-941-4400
Mailing Address - Fax:501-941-4430
Practice Address - Street 1:2006 S PINE ST STE F
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-8179
Practice Address - Country:US
Practice Address - Phone:501-941-4400
Practice Address - Fax:501-941-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR206323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR183459407Medicaid