MEDICARE: GARDEN OAKS PHARMACY 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	183500000X	Pharmacist	0418738	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598751984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDEN OAKS PHARMACY INC

Provider Business Mailing Address
First Line	:	200 GARDEN OAKS DR SW
Second Line	:
City	:	CAMDEN
State	:	AR
Zip	:	71701-3733
Country	:	US
Telephone Number	:	870-836-8176
Fax Number	:	870-836-9122

Provider Business Practice Location Address
First Line	:	200 GARDEN OAKS DR SW
Second Line	:
City	:	CAMDEN
State	:	AR
Zip	:	71701-3733
Country	:	US
Telephone Number	:	870-836-8176
Fax Number	:	870-836-9122

Authorized Official
Title or Position	:	OWNER PHARMACIST
Name	:	MRS. LUCY JACKSON CYPHERS
Credential	:	RPH
Telephone Number	:	870-836-8176

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	12/23/2011

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