Healthcare Provider Details

I. General information

NPI: 1497818967
Provider Name (Legal Business Name): BUNDY FAMILY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 N MAIN ST., SUITE B
HARRISON AR
72601
US

IV. Provider business mailing address

731 N MAIN ST., SUITE B
HARRISON AR
72601
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-2119
  • Fax: 870-741-5572
Mailing address:
  • Phone: 870-741-2119
  • Fax: 870-741-5572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ADDIE BUNDY
Title or Position: OWNER
Credential:
Phone: 870-741-2119