Provider Demographics
NPI:1821371261
Name:ARKANSAS METHODIST HOSP PHCY
Entity Type:Organization
Organization Name:ARKANSAS METHODIST HOSP PHCY
Other - Org Name:ARKANSAS METHODIST HOSP PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:870-239-7861
Mailing Address - Street 1:900 W KINGSHIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5942
Mailing Address - Country:US
Mailing Address - Phone:870-239-7861
Mailing Address - Fax:870-239-7431
Practice Address - Street 1:900 W KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5942
Practice Address - Country:US
Practice Address - Phone:870-239-7861
Practice Address - Fax:870-239-7431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARHP000793336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0408838OtherNCPDP PROVIDER IDENTIFICATION NUMBER