Healthcare Provider Details

I. General information

NPI: 1083754816
Provider Name (Legal Business Name): ICARERX, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 UNITY RD
CROSSETT AR
71635
US

IV. Provider business mailing address

909 UNITY RD
CROSSETT AR
71635-9444
US

V. Phone/Fax

Practice location:
  • Phone: 870-364-5100
  • Fax: 870-364-5120
Mailing address:
  • Phone: 870-364-5100
  • Fax: 870-364-5120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20146
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM ERIC SHOFFNER
Title or Position: PHARMACIST-OWNER
Credential: PD
Phone: 870-364-5100