Provider Demographics
NPI:1023309671
Name:CARESCRIPT PHARMACY, LLC
Entity type:Organization
Organization Name:CARESCRIPT PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-494-0100
Mailing Address - Street 1:2910 JENNY LIND RD
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-6735
Mailing Address - Country:US
Mailing Address - Phone:479-494-0100
Mailing Address - Fax:479-494-0102
Practice Address - Street 1:2910 JENNY LIND RD
Practice Address - Street 2:BUILDING 4
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-6735
Practice Address - Country:US
Practice Address - Phone:479-494-0100
Practice Address - Fax:479-494-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR20636333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAR 20636OtherSTATE LICENSE