Provider Demographics
NPI:1255449831
Name:FRUCHEY, INC
Entity type:Organization
Organization Name:FRUCHEY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-374-2207
Mailing Address - Street 1:400 W CAPITOL AVE STE 101A
Mailing Address - Street 2:REGIONS CENTER
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-3436
Mailing Address - Country:US
Mailing Address - Phone:501-374-2207
Mailing Address - Fax:501-374-2208
Practice Address - Street 1:400 W CAPITOL AVE # 101A
Practice Address - Street 2:REGIONS CENTER
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-3436
Practice Address - Country:US
Practice Address - Phone:501-374-2207
Practice Address - Fax:501-374-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
ARAR184093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1995480OtherPK
AR10594Medicare PIN
AR1262530001Medicare NSC