Provider Demographics
NPI:1457423238
Name:PHC PHARMACIES INC
Entity Type:Organization
Organization Name:PHC PHARMACIES INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:KEMP
Authorized Official - Last Name:SKOKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-793-2161
Mailing Address - Street 1:2080 HARRISON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2080 HARRISON ST
Practice Address - Street 2:SUITE A
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7413
Practice Address - Country:US
Practice Address - Phone:870-793-2161
Practice Address - Fax:870-793-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR332B00000X
AR04191083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139395407Medicaid
0419108OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0419108OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AR139395407Medicaid
0419108OtherOTHER ID NUMBER-COMMERCIAL NUMBER