Healthcare Provider Details

I. General information

NPI: 1699542035
Provider Name (Legal Business Name): PHARMACY CARE OF BENTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 W SOUTH ST STE 1
BENTON AR
72015-4074
US

IV. Provider business mailing address

518 CLAY ST
ARKADELPHIA AR
71923-6024
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-5100
  • Fax: 870-246-6616
Mailing address:
  • Phone: 870-246-5553
  • Fax: 870-246-6616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM PERCY MALONE
Title or Position: PRESIDENT
Credential: RPH
Phone: 870-246-5553