Healthcare Provider Details

I. General information

NPI: 1558764159
Provider Name (Legal Business Name): PREMIER PHARMACY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2014
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 MICHAELA DR.
NORTH LITTLE ROCK AR
72117
US

IV. Provider business mailing address

760 MICHAELA DR.
NORTH LITTLE ROCK AR
72117
US

V. Phone/Fax

Practice location:
  • Phone: 501-992-1006
  • Fax: 501-992-1013
Mailing address:
  • Phone: 501-992-1006
  • Fax: 501-992-1013

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 NumberAR20771
License Number StateAR

VIII. Authorized Official

Name: DR. TRAVIS EZELL
Title or Position: COO
Credential: PHARMD
Phone: 501-992-1006