PPG Store 3, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

AR20840 Issued in AR

Legal business name

PPG STORE 3, LLC

Practice address

11414 W Markham Street
Little Rock, AR 72703

Phone

(501) 904-4299

Fax

(501) 904-4298

NPI assigned

Mar 30, 2016

Organization subpart

No

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

Authorized official

Name

Zach Holderfield, PHARMD

Title

Owner, Ao

Phone

(870) 814-0605

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 2

• Cornerstone Pharmacy Markham Doing business as
• Heartland Pharmacy Markham Doing business as

Medicare fee-for-service enrollment

Enrolled in AR2 enrollments

Enrollment records 2

Locations

Practitioners 1

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

• Stacey Carter Grandison II, PHARMD

  • Pharmacist
  • Little Rock, AR
  • NPI 1902506611
  NPD

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

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1669835484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11414 W MARKHAM STREET",
            "address_2": "SUITE D",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "72703",
            "telephone_number": "501-904-4299",
            "fax_number": "501-904-4298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11414 W MARKHAM STREET",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "72703",
            "telephone_number": "501-904-4299",
            "fax_number": "501-904-4298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PPG STORE 3, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-30",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HOLDERFIELD",
        "authorized_official_first_name": "ZACH",
        "authorized_official_title_or_position": "OWNER, AO",
        "authorized_official_telephone_number": "870-814-0605",
        "authorized_official_credential": "PHARMD"
    },
    "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": "AR20840",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2159147",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cornerstone Pharmacy Markham",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heartland Pharmacy Markham",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cathey L Powers, M.D.
• Cheralyn Hendrix Powers, P.H.D.
• Lindsay Suzanne Powers
• Madison Powers
• Ambre' Lachelle Pownall, APN, PNP-BC
• Petpring Prajuabpansri, M.D.
• Krishnappa Arthur Prasad, MD
• Sirinya Prasertvit, MD
• Tabitha Prater, RD
• Ann Marie Prather, PH.D.

• Community/Retail Pharmacy in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Community/Retail Pharmacy in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.