Provider Demographics
NPI:1063599934
Name:TOTTY ENTERPRISES INC.
Entity type:Organization
Organization Name:TOTTY ENTERPRISES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:TOTTY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:870-687-3814
Mailing Address - Street 1:PO 627
Mailing Address - Street 2:
Mailing Address - City:BEARDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71720
Mailing Address - Country:US
Mailing Address - Phone:870-687-3814
Mailing Address - Fax:870-687-3600
Practice Address - Street 1:26 NW 1ST STREET
Practice Address - Street 2:
Practice Address - City:BEARDEN
Practice Address - State:AR
Practice Address - Zip Code:71720
Practice Address - Country:US
Practice Address - Phone:870-687-3814
Practice Address - Fax:870-687-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR182193336C0003X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1995389OtherPK
AR124201407Medicaid