Provider Demographics
NPI:1477547362
Name:WPM COMMUNITY PHARMACIES, LLC
Entity type:Organization
Organization Name:WPM COMMUNITY PHARMACIES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-403-9400
Mailing Address - Street 1:PO BOX 524
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-6024
Mailing Address - Country:US
Mailing Address - Phone:870-403-9400
Mailing Address - Fax:870-245-1790
Practice Address - Street 1:710 N WEST AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4655
Practice Address - Country:US
Practice Address - Phone:870-863-8111
Practice Address - Fax:870-863-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
ARAR025713336L0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992910OtherPK
AR149142716Medicaid
AR149142716Medicaid
0703720001Medicare NSC