Provider Demographics
NPI:1750859195
Name:COMMUNITY CARE RX LLC
Entity Type:Organization
Organization Name:COMMUNITY CARE RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELYN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-844-1785
Mailing Address - Street 1:1606 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-2006
Mailing Address - Country:US
Mailing Address - Phone:501-229-1446
Mailing Address - Fax:501-229-1397
Practice Address - Street 1:1606 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-2006
Practice Address - Country:US
Practice Address - Phone:501-229-1446
Practice Address - Fax:501-229-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-03
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1750859195Medicaid