Provider Demographics
NPI:1962636829
Name:WHITEHALL PHARMACY LLC
Entity Type:Organization
Organization Name:WHITEHALL PHARMACY LLC
Other - Org Name:DOCTOR'S ORDERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:LELAN
Authorized Official - Last Name:STICE
Authorized Official - Suffix:
Authorized Official - Credentials:PD, MBA
Authorized Official - Phone:870-850-8010
Mailing Address - Street 1:7240 SHERIDAN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-3272
Mailing Address - Country:US
Mailing Address - Phone:870-850-8010
Mailing Address - Fax:870-850-8014
Practice Address - Street 1:7240 SHERIDAN RD STE 102
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-3272
Practice Address - Country:US
Practice Address - Phone:870-850-8010
Practice Address - Fax:870-850-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR206083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAR20608OtherARKANSAS STATE BOARD OF PHARMACY
AR177297407Medicaid