Provider Demographics
NPI:1821537929
Name:HAMBURG PHARMACY
Entity Type:Organization
Organization Name:HAMBURG PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-415-1372
Mailing Address - Street 1:302 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:AR
Mailing Address - Zip Code:71646-3230
Mailing Address - Country:US
Mailing Address - Phone:870-853-2191
Mailing Address - Fax:870-853-2199
Practice Address - Street 1:302 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:AR
Practice Address - Zip Code:71646-3230
Practice Address - Country:US
Practice Address - Phone:870-853-2191
Practice Address - Fax:870-853-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR219185407Medicaid