NPIMap

Organization Active NPI

Bundy Family Pharmacy LLC

  • Pharmacy
  • Harrison, AR
National Provider Identifier
1497818967
Registry record updated Oct 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
BUNDY FAMILY PHARMACY LLC
Practice address
731 N Main St., Suite B
Harrison, AR 72601
Phone
(870) 741-2119
Fax
(870) 741-5572
NPI assigned
Dec 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2022

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

Authorized official

Name
Addie BundyNPI 1336952969
Title
Owner
Phone
(870) 741-2119

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

731 N Main St., Suite B
Harrison, AR 72601

Mailing address

731 N Main St., Suite B
Harrison, AR 72601
Phone (870) 741-2119

Other identifiers 1

IdentifierTypeStateIssuer
143606407MedicaidAR

Other names 1

  • Sullivan Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221019001462 AR Part B Supplier - Pharmacy 6002282886 Practice locations: Harrison, AR

National Provider Directory

National Provider Directory
Tax ID family
Bundy Family Pharmacy LLC2 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.

Locations

731 N Main St
#B
Harrison, AR 72601
Phone (870) 741-2119

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1497818967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 N MAIN ST., SUITE B",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "72601",
            "telephone_number": "870-741-2119",
            "fax_number": "870-741-5572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 N MAIN ST., SUITE B",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "72601",
            "telephone_number": "870-741-2119",
            "fax_number": "870-741-5572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUNDY FAMILY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A",
        "authorized_official_last_name": "BUNDY",
        "authorized_official_first_name": "ADDIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-741-2119"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143606407",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sullivan Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sullivan Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harrison, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 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.

Verify at the official NPI Registry.