PPG Store 7 LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PPG STORE 7 LLC

Practice address

102 N 27TH St
Arkadelphia, AR 71923-4368

Phone

(870) 464-9560

Fax

(870) 464-9561

NPI assigned

Dec 15, 2020

Organization subpart

No

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

Authorized official

Name

Clint Boone, PHARMD

Title

Owner

Phone

(870) 464-9560

Specialties & licenses 2

Addresses

Other names 1

• Heartland Pharmacy Arkadelphia Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fawn Jackson, RPH

  • Pharmacist
  • Arkadelphia, AR
  • NPI 1366320897
  NPD

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

{
    "created_epoch": "1607990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621555200000",
    "number": "1265028120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 SALEM RD STE 220",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720344855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 N 27TH ST",
            "city": "ARKADELPHIA",
            "state": "AR",
            "postal_code": "719234368",
            "telephone_number": "870-464-9560",
            "fax_number": "870-464-9561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PPG STORE 7 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-15",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-06",
        "status": "A",
        "authorized_official_last_name": "BOONE",
        "authorized_official_first_name": "CLINT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-464-9560",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Pharmacy Arkadelphia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heartland Pharmacy Arkadelphia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Haley Charlene Pilgreen, OT
• Anne Elizabeth Pless, R.PH.
• Catherine Plyler, PHARMD
• Jessica R Poe
• Sue W. Poole, L.C.S.W.
• Kelly Presley
• Hannah A Prince
• Emily Pullin
• Kaneil Purifoy, LPC
• Keri Morgan Purifoy

• Community/Retail Pharmacy in Arkadelphia, AR
• Providers in Arkadelphia, 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 May 21, 2021; 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.