PPG Store 5, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PPG STORE 5, LLC

Practice address

2006 S Pine St
Suite F
Cabot, AR 72023-9386

Phone

(501) 941-4400

Fax

(501) 941-4430

NPI assigned

Feb 16, 2017

Organization subpart

No

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

Authorized official

Name

Zach Holderfield

Title

Pharmacist

Phone

(501) 941-4400

Specialties & licenses 1

Addresses

Other names 1

• Heartland Pharmacy Cabot Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 1

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

• Roxanne Marie Wetzler, PHARM.D.

  • Pharmacist
  • Cabot, AR
  • NPI 1649867169
  NPD (past)

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

{
    "created_epoch": "1487203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487203200000",
    "number": "1689113136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8070",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727030001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2006 S PINE ST",
            "address_2": "SUITE F",
            "city": "CABOT",
            "state": "AR",
            "postal_code": "720239386",
            "telephone_number": "501-941-4400",
            "fax_number": "501-941-4430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PPG STORE 5, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-16",
        "last_updated": "2017-02-16",
        "status": "A",
        "authorized_official_last_name": "HOLDERFIELD",
        "authorized_official_first_name": "ZACH",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "501-941-4400"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Pharmacy Cabot",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Poindexter
• Denisse Pollo, PLMSW
• Michael R Poppy, APRN
• Andrew J Powell, M.D.
• Brooklyn Grace Powell
• Jennifer Lynn Price, DNP
• Professional Counseling Associates Inc.
• Robin Pruett, MCD-CCC-SLP
• Noah Rabb
• Destiny Rainbolt

• All providers in Cabot, AR
• Community/Retail Pharmacy in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2017; 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.