Provider Demographics
NPI:1780681932
Name:FUTRELL PHARMACY INC
Entity type:Organization
Organization Name:FUTRELL PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:FUTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-892-5615
Mailing Address - Street 1:115 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-3402
Mailing Address - Country:US
Mailing Address - Phone:870-892-5616
Mailing Address - Fax:870-892-2592
Practice Address - Street 1:115 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-3402
Practice Address - Country:US
Practice Address - Phone:870-892-5616
Practice Address - Fax:870-892-2592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR110305716332B00000X
AR122010733332BP3500X
3336L0003X
ARAR05743333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110305716Medicaid
AR122010733Medicaid
AR0405743OtherNABP #
AR100288407Medicaid
ARAF3212898OtherDEA #
AR122010733Medicaid
AR0777940001Medicare NSC