Medical Park Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

AR20264 Issued in AR

Legal business name

MEDICAL PARK PHARMACY LLC

Practice address

121 E Van Buren Ste C
Eureka Springs, AR 72632-3658

Phone

(479) 253-9751

Fax

(479) 253-7149

NPI assigned

Apr 10, 2006

Organization subpart

No

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

Authorized official

Name

Vada McCallough, RPH

Title

Owner

Phone

(479) 253-9751

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• MEDICAL PARK PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490572800000",
    "number": "1558324624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 E. VANBUREN",
            "address_2": "SUITE C",
            "city": "EUREKA SPRINGS",
            "state": "AR",
            "postal_code": "72632",
            "telephone_number": "479-253-9751",
            "fax_number": "479-253-7149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 E VAN BUREN STE C",
            "city": "EUREKA SPRINGS",
            "state": "AR",
            "postal_code": "726323658",
            "telephone_number": "479-253-9751",
            "fax_number": "479-253-7149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL PARK PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2017-03-27",
        "status": "A",
        "authorized_official_last_name": "MCCALLOUGH",
        "authorized_official_first_name": "VADA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-253-9751",
        "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": "AR20264",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "605854900",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1992914",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142172407",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICAL PARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jon Del Loudermilk, M.D.
• LTC of Eureka Springs, LLC
• Keili Adiyah Lumiere, PH.D.
• Vada Beth McCullough, RPH
• Heather McLoud, PMHNP
• Mediquest Inc.
• Mercy Clinic Springfield Communities
• Mercy Hospital Springfield
• Sonjia Ilene Michaels, D.C.
• Michael Edward Murphy, APN

• All providers in Eureka Springs, AR
• Community/Retail Pharmacy in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 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.