Provider Demographics
NPI:1659866341
Name:HAYES NEWARK PHARMACY LLC
Entity Type:Organization
Organization Name:HAYES NEWARK PHARMACY LLC
Other - Org Name:NEWARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:870-799-3411
Mailing Address - Street 1:503 VINE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:AR
Mailing Address - Zip Code:72562-9711
Mailing Address - Country:US
Mailing Address - Phone:870-799-3411
Mailing Address - Fax:870-799-8439
Practice Address - Street 1:503 VINE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:AR
Practice Address - Zip Code:72562
Practice Address - Country:US
Practice Address - Phone:870-799-3411
Practice Address - Fax:870-799-8439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR229773407Medicaid