NPIMap

Organization Active NPI

Premier Pharmacy Care LLC

  • Long Term Care Pharmacy
  • North Little Rock, AR
National Provider Identifier
1558764159
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
AR20771 Issued in AR
Legal business name
PREMIER PHARMACY CARE LLC
Doing business as
Premier Pharmacy Care LLC
Practice address
760 Michaela Dr.
North Little Rock, AR 72117
Phone
(501) 992-1006
Fax
(501) 992-1013
NPI assigned
Sep 27, 2014
Last updated
Jul 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

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

Authorized official

Name
Dr. Travis Ezell, PHARMDNPI 1154938082
Title
Coo
Phone
(501) 992-1006

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 NU
Long Term Care Pharmacy 3336L0003X AR20771 AR Primary

Addresses

Primary practice location

760 Michaela Dr.
North Little Rock, AR 72117

Mailing address

760 Michaela Dr.
North Little Rock, AR 72117
Phone (501) 992-1006

Other identifiers 1

IdentifierTypeStateIssuer
2148229OtherPK

Other names 1

  • Premier Pharmacy Care LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20171010000131 AR Part B Supplier - Pharmacy 3779858246 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: North Little Rock, AR; Springdale, AR
O20201218002144 AR Part B Supplier - Mass Immunization (Roster Biller Only) 3779858246 Practice locations: North Little Rock, AR

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Premier Pharmacy Care 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

760 Michaela Dr
North Little Rock, AR 72117
Phone (501) 992-1006

834 E Henri de Tonti Blvd
Tontitown, AR 72762
Phone (479) 927-6100

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1411776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753228800000",
    "number": "1558764159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 MICHAELA DR.",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "72117",
            "telephone_number": "501-992-1006",
            "fax_number": "501-992-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 MICHAELA DR.",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "72117",
            "telephone_number": "501-992-1006",
            "fax_number": "501-992-1013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PHARMACY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-27",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A",
        "authorized_official_last_name": "EZELL",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "501-992-1006",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "AR",
            "license": "AR20771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2148229",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Pharmacy Care LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Premier Pharmacy Care LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; 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.