Healthcare Provider Details

I. General information

NPI: 1609879808
Provider Name (Legal Business Name): HEALTH DEPOT PHARMACIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 HWY 271 S
FT. SMITH AR
72908
US

IV. Provider business mailing address

7700 HWY 271 S.
FT. SMITH AR
72908
US

V. Phone/Fax

Practice location:
  • Phone: 479-649-9500
  • Fax: 479-649-9504
Mailing address:
  • Phone: 479-649-9500
  • Fax: 479-649-9504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateAR

VIII. Authorized Official

Name: HARRISON ALEXANDER HALL
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 479-649-9500