Healthcare Provider Details

I. General information

NPI: 1376338780
Provider Name (Legal Business Name): HNK PHARM, PLLC LTC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W MAIN ST
LAVACA AR
72941-3802
US

IV. Provider business mailing address

1800 W MAIN ST
LAVACA AR
72941-3802
US

V. Phone/Fax

Practice location:
  • Phone: 479-674-2222
  • Fax: 479-674-2224
Mailing address:
  • Phone: 479-674-2222
  • Fax: 479-674-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN AHLERT
Title or Position: OWNER
Credential:
Phone: 479-674-2222