PPG Store 4, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PPG STORE 4, LLC

Doing business as

Heartland Pharmacy Mountain Home

Practice address

128 N College St
Mountain Home, AR 72653-3652

Phone

(870) 425-2221

Fax

(870) 424-3332

NPI assigned

Nov 16, 2016

Last updated

Jun 29, 2026By 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

Pharmacist

Phone

(479) 387-3096

Specialties & licenses 1

Addresses

Other names 1

• Heartland Pharmacy Mountain Home Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 1

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.

• Chad Steven Mooney, PHARM.D.

  • Pharmacist
  • Mountain Home, AR
  • NPI 1174110696
  NPD (past)

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

{
    "created_epoch": "1479254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782691200000",
    "number": "1093257420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8070",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727030001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 N COLLEGE ST",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726533652",
            "telephone_number": "870-425-2221",
            "fax_number": "870-424-3332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PPG STORE 4, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-16",
        "last_updated": "2026-06-29",
        "certification_date": "2026-06-29",
        "status": "A",
        "authorized_official_last_name": "HOLDERFIELD",
        "authorized_official_first_name": "ZACH",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "479-387-3096"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Pharmacy Mountain Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hillary-Paige Graves Potter, PA
• Jayma Potter, LCSW
• Jennifer Potts, MHPP
• James Pouncy
• Angela Noel Powell, PHARM.D.
• Lisa Prahl
• Jenna M Prause, FNP
• Preferred Medical Associates LLC
• Haley Priborsky, RD, LD
• Kari L Priborsky, O.D.

• Community/Retail Pharmacy in Mountain Home, AR
• Providers in Mountain Home, 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 29, 2026; 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.