Fountain Lake Family Pharmacy LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

FOUNTAIN LAKE FAMILY PHARMACY LLC

Practice address

4517 Park Ave
Hot Springs, AR 71901

Phone

(501) 547-3400

Fax

(501) 521-1033

NPI assigned

Jul 19, 2023

Organization subpart

No

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

Authorized official

Name

Michael Butler

Title

President

Phone

(501) 547-3400

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Fountain Lake Family Pharm2 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.

• Fountain Lake Family Pharmacy LLC

  • Pharmacy
  • Hot Springs, AR
  • NPI 1164081071
  NPD tax ID

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

{
    "created_epoch": "1689724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689724800000",
    "number": "1831879451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4517 PARK AVE",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "71901",
            "telephone_number": "501-547-3400",
            "fax_number": "501-521-1033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4517 PARK AVE",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "71901",
            "telephone_number": "501-547-3400",
            "fax_number": "501-521-1033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN LAKE FAMILY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-19",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-547-3400"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "236424407",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victor M Fortanelli
• Caroline Anne Foshee, CRNA
• Misty L Foshee, APN
• Jacqueline Marie Foster, MHPP
• Fountain Lake Family Pharmacy LLC
• Fountain Lake Health and Rehab Inc
• Fountain Lake School
• Mikell Foust, APRN, PMHNP-BC
• Lindsay Fowler, M.S., CCC-SLP
• Kaylee Fox - Cox, LCSW

• Long Term Care Pharmacy in Hot Springs, AR
• Providers in Hot Springs, AR by specialty
• Long Term Care Pharmacy in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; 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.