NPIMap

Organization Active NPI

Hyde Pharmacy Inc (Immunization)

  • Community/Retail Pharmacy
  • Paragould, AR
National Provider Identifier
1538597752
Registry record updated Mar 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
AR16734 Issued in AR
Legal business name
HYDE PHARMACY INC (IMMUNIZATION)
Practice address
1001 W Kingshighway
Paragould, AR 72450-4142
Phone
(870) 239-4036
Fax
(870) 239-9478
NPI assigned
Oct 25, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2024

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

Authorized official

Name
Dr. Kenneth Robert Kuenzel, PHARM D
Title
Owner/President
Phone
(870) 239-4036

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X AR16734 AR Primary
Long Term Care Pharmacy 3336L0003X AR16734 AR

Addresses

Primary practice location

1001 W Kingshighway
Paragould, AR 72450-4142

Mailing address

1001 W Kingshighway
Paragould, AR 72450-4142
Phone (870) 239-4036

Other identifiers 2

IdentifierTypeStateIssuer
117466407MedicaidAR
166898716MedicaidAR

National Provider Directory

National Provider Directory
Tax ID family
Hyde Pharmacy Inc3 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.

Locations

1001 W Kingshighway
Paragould, AR 72450
Phone (870) 239-4036

NPI Registry JSON

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

{
    "created_epoch": "1382659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710460800000",
    "number": "1538597752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 W KINGSHIGHWAY",
            "city": "PARAGOULD",
            "state": "AR",
            "postal_code": "724504142",
            "telephone_number": "870-239-4036",
            "fax_number": "870-239-9478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 W KINGSHIGHWAY",
            "city": "PARAGOULD",
            "state": "AR",
            "postal_code": "724504142",
            "telephone_number": "870-239-4036",
            "fax_number": "870-239-9478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HYDE PHARMACY INC (IMMUNIZATION)",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-25",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A",
        "authorized_official_last_name": "KUENZEL",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "870-239-4036",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR16734",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "AR",
            "license": "AR16734",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117466407",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166898716",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paragould, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; 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.