Provider Demographics
NPI:1255416244
Name:ELAINE PHARMACY INC
Entity type:Organization
Organization Name:ELAINE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHUBACH
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-572-7770
Mailing Address - Street 1:806 N SEBASTIAN
Mailing Address - Street 2:
Mailing Address - City:WEST HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72390-1821
Mailing Address - Country:US
Mailing Address - Phone:870-572-7770
Mailing Address - Fax:870-572-7666
Practice Address - Street 1:806 N SEBASTIAN
Practice Address - Street 2:
Practice Address - City:WEST HELENA
Practice Address - State:AR
Practice Address - Zip Code:72390-1821
Practice Address - Country:US
Practice Address - Phone:870-572-7770
Practice Address - Fax:870-572-7666
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELAINE PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-26
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6603183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100778407Medicaid