MEDICARE: FRUCHEY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	AR18409	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1995480	OTHER		PK

General Provider Information

NPI Number	:	1255449831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRUCHEY, INC

Provider Business Mailing Address
First Line	:	400 W CAPITOL AVE STE 101A
Second Line	:	REGIONS CENTER
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-3436
Country	:	US
Telephone Number	:	501-374-2207
Fax Number	:	501-374-2208

Provider Business Practice Location Address
First Line	:	400 W CAPITOL AVE # 101A
Second Line	:	REGIONS CENTER
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-3436
Country	:	US
Telephone Number	:	501-374-2207
Fax Number	:	501-374-2208

Authorized Official
Title or Position	:	OWNER
Name	:	WALTER FRUCHEY
Credential	:	PHARMD
Telephone Number	:	501-374-2207

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	09/19/2025

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