Healthcare Provider Details

I. General information

NPI: 1689355489
Provider Name (Legal Business Name): FRUCHEY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W CAPITOL AVE STE 101A
LITTLE ROCK AR
72201-3436
US

IV. Provider business mailing address

400 W CAPITOL AVE STE 101A
LITTLE ROCK AR
72201-3436
US

V. Phone/Fax

Practice location:
  • Phone: 501-374-2207
  • Fax: 501-374-2208
Mailing address:
  • Phone: 501-374-2207
  • Fax: 501-374-2208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WALTER LYN FRUCHEY
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 501-374-2207