Healthcare Provider Details

I. General information

NPI: 1265580260
Provider Name (Legal Business Name): BOB'S FOOD CITY # 1450
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MALVERN AVE
HOT SPRINGS AR
71901-6230
US

IV. Provider business mailing address

800 MALVERN AVE
HOT SPRINGS AR
71901-6230
US

V. Phone/Fax

Practice location:
  • Phone: 501-624-1208
  • Fax: 501-623-9937
Mailing address:
  • Phone: 501-624-1028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberAR20017
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRENDA MCCRADY
Title or Position: DIRECTOR OF PHARMACY
Credential: BS PHARMACY
Phone: 501-570-0007