Conway Apothecary Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

CONWAY APOTHECARY INC.

Doing business as

Conway Apothecary

Practice address

2125 College Ave Ste 1
Conway, AR 72034-6387

Phone

(501) 327-8088

NPI assigned

Jul 19, 2023

Last updated

Aug 10, 2023By 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

Clayton Dickerson, PHARMDNPI 1568196970

Title

Pharmacist/Owner

Phone

(870) 540-7955

Specialties & licenses 1

Addresses

Other names 1

• Conway Apothecary Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Tax ID family

Conway Apothecary2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Conway Apothecary Inc.

  dba Conway Apothecary

  • Long Term Care Pharmacy
  • Conway, AR
  • NPI 1982384566
  NPD tax ID

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.

• Clayton Andrew Dickerson, PHARMD

  • Pharmacist
  • Danville, AR
  • NPI 1568196970
  NPD Authorized official
• Robert Blake Johnson, PHARM.D.

  • Pharmacist
  • Conway, AR
  • NPI 1043819923
  NPD

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

{
    "created_epoch": "1689724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691625600000",
    "number": "1043990617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 ELDRIDGE LN",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720325018",
            "telephone_number": "870-540-7955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 COLLEGE AVE STE 1",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720346387",
            "telephone_number": "501-327-8088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONWAY APOTHECARY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-19",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "CLAYTON",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "870-540-7955",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Conway Apothecary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brentnie Conner
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• Conway Anesthesiology Consultants, P.a.
• Conway Apothecary Inc. (Conway Apothecary)
• Conway Behavioral Health, LLC (Conway Behavioral Health)
• Conway Behavioral Health, LLC (Conway Behavioral Health)
• Conway Cardiovascular Surgery Center, LLC
• Conway Childrens Clinic PA Corp

• 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 Aug 10, 2023; 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.