Lyon Drug Company Maumelle Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

AR20638 Issued in AR

Legal business name

LYON DRUG COMPANY MAUMELLE INC

Practice address

1900 Club Manor Dr Ste 101
Maumelle, AR 72113-7443

Phone

(501) 803-9400

Fax

(501) 803-9441

NPI assigned

Nov 11, 2010

Organization subpart

No

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

Authorized official

Name

Brent Bradley, RPH

Title

President/Owner/Pic

Phone

(501) 553-3604

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Bradley's Healthmart Doing business as

Locations

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

{
    "created_epoch": "1289433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491350400000",
    "number": "1407157167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 CLUB MANOR DR STE 101",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721137443",
            "telephone_number": "501-803-9400",
            "fax_number": "501-803-9441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 CLUB MANOR DR STE 101",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721137443",
            "telephone_number": "501-803-9400",
            "fax_number": "501-803-9441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYON DRUG COMPANY MAUMELLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-11",
        "last_updated": "2017-04-05",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "PRESIDENT/OWNER/PIC",
        "authorized_official_telephone_number": "501-553-3604",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR20638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "186574407",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2127857",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bradley's Healthmart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jacob Leslie, PHARMD
• Danielle M Lindley, ANP
• Lindsey Health Management, LLC
• Alethia Long
• Derek Scott Long, O.D.
• Magnolia Gem Home Health
• Maje Home Care Agency
• Maumelle Alf Opco LLC
• Maumelle Chiropractic Inc
• Maumelle Eye Care

• Community/Retail Pharmacy in Maumelle, AR
• Providers in Maumelle, 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 Apr 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.