Provider Demographics
NPI:1922142025
Name:HUNTERS PHARMACY, INC
Entity Type:Organization
Organization Name:HUNTERS PHARMACY, INC
Other - Org Name:HUNTER'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND HEAD PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:CROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:870-265-2220
Mailing Address - Street 1:401 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-1731
Mailing Address - Country:US
Mailing Address - Phone:870-265-2220
Mailing Address - Fax:870-265-3538
Practice Address - Street 1:401 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-1731
Practice Address - Country:US
Practice Address - Phone:870-265-2220
Practice Address - Fax:870-265-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X, 332B00000X, 3336L0003X
ARAR203713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150618407Medicaid
AR150618407Medicaid