Active NPI
Pharmacy of Shannon Hills LLC
- Pharmacy
- Mabelvale, AR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- PHARMACY OF SHANNON HILLS LLC
- Practice address
- 13907 High Rd
Mabelvale, AR 72103-3212 - Phone
- (501) 451-7715
- Fax
- (501) 451-7761
- NPI assigned
- Jan 18, 2022
- Last updated
- May 6, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Callie Bench, PHARMD
- Title
- Owner/Pharmacist in Charge
- Phone
- (501) 451-7715
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | NU | Primary |
Addresses
Primary practice location
13907 High Rd
Mabelvale, AR 72103-3212
Mailing address
13907 High Rd
Mabelvale, AR 72103-3212
Phone (501) 451-7715
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220221000756 | AR | Part B Supplier - Pharmacy | 8729472519 | Practice locations: Mabelvale, AR |
National Provider Directory
National Provider Directory- Tax ID family
- Pharmacy of Shannon Hills LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Long Term Care Pharmacy
- Mabelvale, AR
- NPI 1457055972
Practitioners & affiliated clinicians
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.
-
- Pharmacist
- Mabelvale, AR
- NPI 1770188229
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642464000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1651795200000",
"number": "1407508765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13907 HIGH RD",
"city": "MABELVALE",
"state": "AR",
"postal_code": "721033212",
"telephone_number": "501-451-7715",
"fax_number": "501-451-7761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13907 HIGH RD",
"city": "MABELVALE",
"state": "AR",
"postal_code": "721033212",
"telephone_number": "501-451-7715",
"fax_number": "501-451-7761"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PHARMACY OF SHANNON HILLS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-01-18",
"last_updated": "2022-05-06",
"certification_date": "2022-05-06",
"status": "A",
"authorized_official_last_name": "BENCH",
"authorized_official_first_name": "CALLIE",
"authorized_official_title_or_position": "OWNER/PHARMACIST IN CHARGE",
"authorized_official_telephone_number": "501-451-7715",
"authorized_official_credential": "PHARMD"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mabelvale, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; 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.