Provider Demographics
NPI:1851443774
Name:LANDMARK PHARMACY, LLC
Entity Type:Organization
Organization Name:LANDMARK PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-681-2068
Mailing Address - Street 1:3401 ATWOOD RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-6012
Mailing Address - Country:US
Mailing Address - Phone:501-888-2223
Mailing Address - Fax:501-888-7504
Practice Address - Street 1:3401 ATWOOD RD
Practice Address - Street 2:SUITE E
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-6012
Practice Address - Country:US
Practice Address - Phone:501-888-2223
Practice Address - Fax:501-888-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2023-02-14
Deactivation Date:2021-02-03
Deactivation Code:
Reactivation Date:2021-03-04
Provider Licenses
StateLicense IDTaxonomies
ARAR20072333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100352407Medicaid