PPG Store 6 LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

AR20873 Issued in AR

Legal business name

PPG STORE 6 LLC

Practice address

2235 Dave Ward Dr Ste 108
Conway, AR 72034-7040

Phone

(501) 450-0000

Fax

(501) 450-6433

NPI assigned

Dec 11, 2017

Last updated

Apr 18, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Zach Holderfield

Title

Partner/Ao

Phone

(870) 814-0605

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Heartland Pharmacy Conway Other name

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• James Abbott

  • Pharmacist
  • Conway, AR
  • NPI 1962090852
  NPD (past)
• Colby Cormell

  • Pharmacist
  • Conway, AR
  • NPI 1467377127
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524009600000",
    "number": "1013422179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 SALEM RD",
            "address_2": "STE 210",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720344821",
            "telephone_number": "501-450-0000",
            "fax_number": "501-450-6433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 DAVE WARD DR STE 108",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720347040",
            "telephone_number": "501-450-0000",
            "fax_number": "501-450-6433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PPG STORE 6 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-11",
        "last_updated": "2018-04-18",
        "status": "A",
        "authorized_official_last_name": "HOLDERFIELD",
        "authorized_official_first_name": "ZACH",
        "authorized_official_title_or_position": "PARTNER/AO",
        "authorized_official_telephone_number": "870-814-0605"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR20873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2174625",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Pharmacy Conway",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Bridgette J Powell, MSN, PMHNP-BC
• Isabella Rose Powell
• Quincey Powell
• Rebecca Powell, APRN
• Power Spine & Sport PA (Power Chiropractic 5)
• Sloane Ashton Precure, PA-C
• Allison Mae Predmore, RN
• Amanda Blair Presley, LCSW
• Prestige Spine Interventional Pain Management, LLC
• Anna Price

• Community/Retail Pharmacy in Conway, AR
• Providers in Conway, AR by specialty
• Community/Retail Pharmacy in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.