Healthcare Provider Details

I. General information

NPI: 1043340789
Provider Name (Legal Business Name): CAVE CITY PHARMACY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S MAIN ST SUITE C
CAVE CITY AR
72521-9476
US

IV. Provider business mailing address

PO BOX 147
CAVE CITY AR
72521-0147
US

V. Phone/Fax

Practice location:
  • Phone: 870-283-5589
  • Fax: 870-283-5636
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR17041
License Number StateAR

VIII. Authorized Official

Name: JENNIFER DAVIS
Title or Position: OWNER
Credential:
Phone: 501-412-7413