Provider Demographics
NPI:1013473263
Name:HEALTH DEPOT PHARMACIES, LLC
Entity type:Organization
Organization Name:HEALTH DEPOT PHARMACIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BREANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-646-7875
Mailing Address - Street 1:7700 HIGHWAY 271 S
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-8028
Mailing Address - Country:US
Mailing Address - Phone:479-646-7875
Mailing Address - Fax:479-646-3090
Practice Address - Street 1:7700 HIGHWAY 271 S
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-8028
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:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy