Healthcare Provider Details

I. General information

NPI: 1245228824
Provider Name (Legal Business Name): MEDIC PHARMACY OF BRYANT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2005
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 N REYNOLDS RD
BRYANT AR
72022-3440
US

IV. Provider business mailing address

306 N REYNOLDS RD
BRYANT AR
72022-3440
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-3596
  • Fax: 501-847-9020
Mailing address:
  • Phone: 501-847-3596
  • Fax: 501-847-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberAR01240
License Number StateAR

VIII. Authorized Official

Name: MR. BRYANT SIZEMORE
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 501-847-3596