Bryant Holifield & Davis Pharmacy
Organization Active NPI Community/Retail Pharmacy · Newport, AR
NPI 1043290299 · NPPES record last updated May 9, 2019
Key facts
- NPI
- 1043290299
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- AR-20190 (AR)
- Legal business name
- BRYANT HOLIFIELD & DAVIS PHARMACY
- Practice address
- 2200 Malcolm Avenue Suite D
Newport, AR 72112 - Phone
- (870) 523-9472
- Fax
- (870) 523-9364
- NPI assigned
- Jan 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Miss Mary Kathryn Davis, PHARMD
- Title
- Officer/Secretary
- Phone
- (870) 523-9472
Corporate family (same tax ID) 1
Practitioners 2
-
Mary Kathryn Davis, PHARMD
-
Lori Ward, PHARM D
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180430002039 | AR | Part B Supplier - Mass Immunization (Roster Biller Only) | 3577827450 | Practice locations: Newport, AR |
National Provider Directory
- Tax ID family
- Bryant Holifield Davis Pharmacy
Locations
2200 Malcolm Ave
Ste D
Newport, AR 72112
Phone (870) 523-9472
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | AR 20190 | AR | |
| Community/Retail Pharmacy | 3336C0003X | AR-20190 | AR | Yes |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
2200 Malcolm Avenue Suite D
Newport, AR 72112
Mailing address
2200 Malcolm Avenue Suite D
Newport, AR 72112
Phone (870) 523-9472
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 138576407 | Medicaid | AR |
Other names
- Norman and Baker Pharmacy
Other providers in Newport, AR
- Jeremy Brown
- Michael W Brown
- Sarah Brooke Brown
- Deanna Dawn Browning
- Jonathan David Brumfield
- Bryant Holifield & Davis Pharmacy
- Michael Bryant Jr.
- Lindsey Burgess
- Stephanie Ann Burgess
- Allen Busby
All providers in Newport, AR · Community/Retail Pharmacy in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.