Provider Demographics
NPI:1861493447
Name:HAMPTON MEDICAL PHARMACY
Entity Type:Organization
Organization Name:HAMPTON MEDICAL PHARMACY
Other - Org Name:HAMPTON MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHRM
Authorized Official - Phone:870-798-4247
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:AR
Mailing Address - Zip Code:71744-0719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:344 S LEE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:AR
Practice Address - Zip Code:71744-0732
Practice Address - Country:US
Practice Address - Phone:870-798-4247
Practice Address - Fax:870-798-4934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR106553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100665407Medicaid
0410655OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1024810001Medicare NSC