Provider Demographics
NPI:1710069489
Name:HAMILTON WEST FAMILY PHARMACY
Entity Type:Organization
Organization Name:HAMILTON WEST FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WACASTER
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:501-767-5333
Mailing Address - Street 1:1629 AIRPORT RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7951
Mailing Address - Country:US
Mailing Address - Phone:501-767-5333
Mailing Address - Fax:501-760-7845
Practice Address - Street 1:1629 AIRPORT RD
Practice Address - Street 2:SUITE D
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7951
Practice Address - Country:US
Practice Address - Phone:501-767-5333
Practice Address - Fax:501-760-7845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR18372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0418372OtherNAPB NUMER
AR125060407Medicaid