Provider Demographics
NPI:1669712428
Name:EAGLE RX, PLLC
Entity type:Organization
Organization Name:EAGLE RX, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:501-268-9400
Mailing Address - Street 1:2412 E. RACE AVE.
Mailing Address - Street 2:SUITE F
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143
Mailing Address - Country:US
Mailing Address - Phone:501-268-9400
Mailing Address - Fax:501-268-9405
Practice Address - Street 1:2412 E. RACE AVE.
Practice Address - Street 2:SUITE F
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143
Practice Address - Country:US
Practice Address - Phone:501-268-9400
Practice Address - Fax:501-268-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR207073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0424262OtherNCPDP PROVIDER IDENTIFICATION NUMBER