Prescription Store of Fordyce Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

AR14893 Issued in AR

Legal business name

PRESCRIPTION STORE OF FORDYCE INC

Doing business as

The Prescription Store

Practice address

1115 W 4TH St
Fordyce, AR 71742-2001

Phone

(870) 352-8631

Fax

(870) 352-8183

NPI assigned

Feb 7, 2007

Last updated

Feb 16, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jon Dean

Title

President

Phone

(870) 352-8631

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• THE PRESCRIPTION STORE Doing business as

Locations

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1851431399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 W 4TH ST",
            "city": "FORDYCE",
            "state": "AR",
            "postal_code": "717422001",
            "telephone_number": "870-352-8631",
            "fax_number": "870-352-8183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 W 4TH ST",
            "city": "FORDYCE",
            "state": "AR",
            "postal_code": "717422001",
            "telephone_number": "870-352-8631",
            "fax_number": "870-352-8183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCRIPTION STORE OF FORDYCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "DEAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "870-352-8631"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR14893",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11249907",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0414893",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE PRESCRIPTION STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeanna Pennington, LPC
• Debra Perry, MHPP
• Emily Phillips, QBHP
• Pine Forest Health and Rehab Center, LLC (dba Dallas County Nursing Home)
• Pioneer Health Services, Inc. (PHS of Dallas)
• Judy Prince, LPC
• Kenneth Michael Prince, MHPP
• Robin Johnston Radford, MHPP
• Madeline Reed, DNP, APRN, PMHNP-BC
• Norma Riggan Rice, MHPP

• Community/Retail Pharmacy in Fordyce, AR
• Providers in Fordyce, 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 Feb 16, 2012; 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.