Provider Demographics
NPI:1154545788
Name:HEALTHCARE PHARMACY, INC.
Entity type:Organization
Organization Name:HEALTHCARE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDIENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:501-888-7514
Mailing Address - Street 1:3401 ATWOOD RD STE F
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-6012
Mailing Address - Country:US
Mailing Address - Phone:501-888-7514
Mailing Address - Fax:501-888-7504
Practice Address - Street 1:3401 ATWOOD RD STE F
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-6012
Practice Address - Country:US
Practice Address - Phone:501-888-7514
Practice Address - Fax:501-888-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR04162153336I0012X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149687407Medicaid