Fountain Lake Family Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

FOUNTAIN LAKE FAMILY PHARMACY LLC

Practice address

4517 Park Ave
Suite B
Hot Springs, AR 71901

Phone

(501) 547-3400

Fax

(844) 805-7790

NPI assigned

Jun 13, 2019

Organization subpart

No

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

Authorized official

Name

Michael David Butler, PHARMD

Title

Owner

Phone

(501) 547-3400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR2 enrollments

Enrollment records 2

Tax ID family

Fountain Lake Family Pharm2 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.

• Fountain Lake Family Pharmacy LLC

  • Long Term Care Pharmacy
  • Hot Springs, AR
  • NPI 1831879451
  NPD tax ID

Locations

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

{
    "created_epoch": "1560384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1164081071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4517 PARK AVE",
            "address_2": "SUITE B",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "71901",
            "telephone_number": "501-547-3400",
            "fax_number": "844-805-7790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4517 PARK AVE",
            "address_2": "SUITE B",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "71901",
            "telephone_number": "501-547-3400",
            "fax_number": "844-805-7790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN LAKE FAMILY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-13",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-547-3400",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fort Smith Artificial Limb and Brace, Inc.
• Victor M Fortanelli
• Caroline Anne Foshee, CRNA
• Misty L Foshee, APN
• Jacqueline Marie Foster, MHPP
• Fountain Lake Family Pharmacy LLC
• Fountain Lake Health and Rehab Inc
• Fountain Lake School
• Mikell Foust, APRN, PMHNP-BC
• Lindsay Fowler, M.S., CCC-SLP

• All providers in Hot Springs, AR
• Pharmacy in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.