Provider Demographics
NPI:1588362545
Name:CYF PHARMACY, LLC
Entity type:Organization
Organization Name:CYF PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:DAWOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:RASSAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-569-0120
Mailing Address - Street 1:1521 MERRILL DR STE D240
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1821
Mailing Address - Country:US
Mailing Address - Phone:501-660-6897
Mailing Address - Fax:501-954-7794
Practice Address - Street 1:1521 MERRILL DR STE D240
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1821
Practice Address - Country:US
Practice Address - Phone:501-660-6897
Practice Address - Fax:501-954-7794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR237937407Medicaid