Provider Demographics
NPI:1831274125
Name:PHARMACEUTICAL INVESTMENT CORP.
Entity type:Organization
Organization Name:PHARMACEUTICAL INVESTMENT CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:479-782-8209
Mailing Address - Street 1:PO BOX 1588
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72902-1588
Mailing Address - Country:US
Mailing Address - Phone:479-782-8209
Mailing Address - Fax:
Practice Address - Street 1:507 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4640
Practice Address - Country:US
Practice Address - Phone:479-782-8209
Practice Address - Fax:479-783-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR203323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992741OtherPK
AR100027407Medicaid
OK100231580AMedicaid
OK100231580AMedicaid