Healthcare Provider Details

I. General information

NPI: 1487675310
Provider Name (Legal Business Name): HYDE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W KINGSHIGHWAY
PARAGOULD AR
72450
US

IV. Provider business mailing address

1001 W KINGSHIGHWAY
PARAGOULD AR
72450-4142
US

V. Phone/Fax

Practice location:
  • Phone: 870-239-4036
  • Fax: 870-239-9478
Mailing address:
  • Phone: 870-239-4036
  • Fax: 870-239-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR16734
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberAR16734
License Number StateAR

VIII. Authorized Official

Name: DR. KENNETH ROBERT KUENZEL
Title or Position: PRESIDENT
Credential: PHARM D
Phone: 870-239-4036