Provider Demographics
NPI:1699542035
Name:PHARMACY CARE OF BENTON, LLC
Entity type:Organization
Organization Name:PHARMACY CARE OF BENTON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PERCY
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:870-246-5553
Mailing Address - Street 1:518 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-6024
Mailing Address - Country:US
Mailing Address - Phone:870-246-5553
Mailing Address - Fax:870-246-6616
Practice Address - Street 1:1016 W SOUTH ST STE 1
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-4074
Practice Address - Country:US
Practice Address - Phone:501-315-5100
Practice Address - Fax:870-246-6616
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:W P MALONE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy