Medic Pharmacy Inc of El Dorado

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MEDIC PHARMACY INC OF EL DORADO

Doing business as

Medic Pharmacy

Practice address

347 W Oak Street
El Dorado, AR 71730-4521

Phone

(870) 862-4931

Fax

(870) 862-6659

NPI assigned

Sep 1, 2005

Last updated

Jun 22, 2020By 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

Mr. William Richard Hanry, RPH

Title

Pharmacist/Owner

Phone

(870) 862-4931

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• Medic Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Medic Pharmacy Inc of El Dorado

  • Durable Medical Equipment & Medical Supplies
  • El Dorado, AR
  • NPI 1235110644

  5092929802

  Same PAC ID

Tax ID family

Medic Pharmacies of El3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Medic Pharmacy Inc of El Dorado

  • Durable Medical Equipment & Medical Supplies
  • El Dorado, AR
  • NPI 1235110644
  NPD tax ID
• Medic Pharmacy Inc of El Dorado

  dba Medic Pharmacy

  • Long Term Care Pharmacy
  • El Dorado, AR
  • NPI 1912537713
  NPD tax ID

Locations

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

{
    "created_epoch": "1125532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592784000000",
    "number": "1083608319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "347 W OAK ST SUITE A",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717304564",
            "telephone_number": "870-862-4931",
            "fax_number": "870-862-6659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "347 W OAK STREET",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717304521",
            "telephone_number": "870-862-4931",
            "fax_number": "870-862-6659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDIC PHARMACY INC OF EL DORADO",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-01",
        "last_updated": "2020-06-22",
        "certification_date": "2020-06-22",
        "status": "A",
        "authorized_official_last_name": "HANRY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "870-862-4931",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "14540",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "AR",
            "license": "AR14540",
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100136407",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in El Dorado, AR
• Providers in El Dorado, 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 Jun 22, 2020; 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.