Provider Demographics
NPI:1710597778
Name:OUACHITA COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:OUACHITA COUNTY MEDICAL CENTER
Other - Org Name:OCMC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIVELY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:870-836-1303
Mailing Address - Street 1:PO BOX 797
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71711-0797
Mailing Address - Country:US
Mailing Address - Phone:870-836-1296
Mailing Address - Fax:870-836-1041
Practice Address - Street 1:638 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-4604
Practice Address - Country:US
Practice Address - Phone:870-836-1296
Practice Address - Fax:870-836-1041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUACHITA COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARHP01082OtherARKANSAS STATE BOARD OF PHARMACY
0427066OtherNCPDP
AR306813407Medicaid