Provider Demographics
NPI:1730653155
Name:FRONTIER PHARMACY
Entity type:Organization
Organization Name:FRONTIER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:OVERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:720-254-3152
Mailing Address - Street 1:104 MILLENIUM PARK DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:AR
Mailing Address - Zip Code:71929
Mailing Address - Country:US
Mailing Address - Phone:501-214-6100
Mailing Address - Fax:
Practice Address - Street 1:104 MILLENIUM PARK DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:AR
Practice Address - Zip Code:71929
Practice Address - Country:US
Practice Address - Phone:501-214-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAR20896OtherSTATE PHARMACY LICENSE
AR232588407Medicaid