Healthcare Provider Details

I. General information

NPI: 1124313267
Provider Name (Legal Business Name): HOT SPRINGS PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 AIRPORT RD
HOT SPRINGS AR
71913-5334
US

IV. Provider business mailing address

PO BOX 2085
HOT SPRINGS AR
71914-2085
US

V. Phone/Fax

Practice location:
  • Phone: 501-760-2444
  • Fax: 501-760-2449
Mailing address:
  • Phone: 501-760-2444
  • Fax: 501-760-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberAR20658
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20658
License Number StateAR

VIII. Authorized Official

Name: MS. ADUSTON STANFORD SPIVEY
Title or Position: PIC, MANAGING PARTNER
Credential: RPH
Phone: 501-767-0573