Healthcare Provider Details

I. General information

NPI: 1083608319
Provider Name (Legal Business Name): MEDIC PHARMACY INC OF EL DORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 W OAK STREET
EL DORADO AR
71730-4521
US

IV. Provider business mailing address

347 W OAK ST SUITE A
EL DORADO AR
71730-4564
US

V. Phone/Fax

Practice location:
  • Phone: 870-862-4931
  • Fax: 870-862-6659
Mailing address:
  • Phone: 870-862-4931
  • Fax: 870-862-6659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14540
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberAR14540
License Number StateAR
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM RICHARD HANRY
Title or Position: PHARMACIST/OWNER
Credential: RPH
Phone: 870-862-4931