Provider Demographics
NPI:1295296614
Name:HARRISON FAMILY PHARMACY, P.L.L.C.
Entity type:Organization
Organization Name:HARRISON FAMILY PHARMACY, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:BOB
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:870-919-4636
Mailing Address - Street 1:2323 N HIGHWAY 229 STE A
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-7202
Mailing Address - Country:US
Mailing Address - Phone:501-794-6338
Mailing Address - Fax:501-794-6348
Practice Address - Street 1:2323 N HIGHWAY 229 STE A
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-7202
Practice Address - Country:US
Practice Address - Phone:870-919-4636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR233508407Medicaid