Provider Demographics
NPI:1487104725
Name:DEBBIE'S FAMILY PHARMACY, INC.
Entity type:Organization
Organization Name:DEBBIE'S FAMILY PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MIZE
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:479-271-6300
Mailing Address - Street 1:5403 W PINNACLE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8118
Mailing Address - Country:US
Mailing Address - Phone:479-271-6300
Mailing Address - Fax:479-271-6305
Practice Address - Street 1:5403 W PINNACLE POINTE DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8118
Practice Address - Country:US
Practice Address - Phone:479-254-8900
Practice Address - Fax:479-254-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
ARAR202043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139264407Medicaid
2164562OtherPK