NPIMap

Organization Active NPI

Medic Pharmacy Inc of El Dorado

  • Durable Medical Equipment & Medical Supplies
  • El Dorado, AR
National Provider Identifier
1235110644
Registry record updated Jun 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
4623060001 Issued in AR
Legal business name
MEDIC PHARMACY INC OF EL DORADO
Practice address
347 W Oak Street
El Dorado, AR 71730-4521
Phone
(870) 862-4931
Fax
(870) 862-6659
NPI assigned
Nov 11, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2020

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 4623060001 AR Primary

Addresses

Primary practice location

347 W Oak Street
El Dorado, AR 71730-4521

Mailing address

347 W Oak Street
El Dorado, AR 71730-4521
Phone (870) 862-4931

Other identifiers 2

IdentifierTypeStateIssuer
100136407MedicaidAR
149261716MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930072170 AR DME Supplier - Pharmacy 5092929802 Practice locations: El Dorado, AR

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
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.

NPI Registry JSON

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

{
    "created_epoch": "1131667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592784000000",
    "number": "1235110644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": "2005-11-11",
        "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": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AR",
            "license": "4623060001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100136407",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149261716",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Dorado, AR

Sources for this page

  • 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.