MEDICARE: HEALTH DEPOT PHARMACIES, LLC

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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1295291441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH DEPOT PHARMACIES, LLC

Provider Business Mailing Address
First Line	:	7700 HWY 271 S
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8028
Country	:	US
Telephone Number	:	479-646-7875
Fax Number	:	479-646-7875

Provider Business Practice Location Address
First Line	:	1610 FORT ST
Second Line	:
City	:	BARLING
State	:	AR
Zip	:	72923-2018
Country	:	US
Telephone Number	:	479-452-1237
Fax Number	:	479-452-7953

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN HENRY HALL
Credential	:	RPH
Telephone Number	:	479-646-7875

Provider Enumeration Date	:	02/13/2019
Last Update Date	:	09/14/2023

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