Provider Demographics
NPI:1952317687
Name:HEALTH DEPOT PHARMACIES, LLC
Entity Type:Organization
Organization Name:HEALTH DEPOT PHARMACIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF PHARMACY
Authorized Official - Phone:479-646-7875
Mailing Address - Street 1:7700 HWY 271 SOUTH
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908
Mailing Address - Country:US
Mailing Address - Phone:479-646-7875
Mailing Address - Fax:479-646-3090
Practice Address - Street 1:7700 HWY 271 SOUTH
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908
Practice Address - Country:US
Practice Address - Phone:479-646-7875
Practice Address - Fax:479-646-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
ARAR200803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992739OtherPK
AR221377407Medicaid
1310550001Medicare NSC