Provider Demographics
NPI:1760470520
Name:HEALTHCARE PHARMACY, INC.
Entity Type:Organization
Organization Name:HEALTHCARE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:501-888-7514
Mailing Address - Street 1:3401 ATWOOD RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-6012
Mailing Address - Country:US
Mailing Address - Phone:501-888-7514
Mailing Address - Fax:501-888-7504
Practice Address - Street 1:3401 ATWOOD RD
Practice Address - Street 2:SUITE F
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-6012
Practice Address - Country:US
Practice Address - Phone:501-888-7514
Practice Address - Fax:501-888-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116749407Medicaid