Provider Demographics
NPI:1285349530
Name:WHITEHALL PHARMACY LLC
Entity type:Organization
Organization Name:WHITEHALL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:LELAN
Authorized Official - Last Name:STICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-380-6901
Mailing Address - Street 1:2302 W 28TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-5081
Mailing Address - Country:US
Mailing Address - Phone:501-442-4657
Mailing Address - Fax:
Practice Address - Street 1:2701 E HARDING AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-6849
Practice Address - Country:US
Practice Address - Phone:870-380-6901
Practice Address - Fax:870-380-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-20
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy