Healthcare Provider Details

I. General information

NPI: 1447590146
Provider Name (Legal Business Name): WHITEHALL PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 W 28TH AVE STE B
PINE BLUFF AR
71603-5081
US

IV. Provider business mailing address

2302 W 28TH AVE STE B
PINE BLUFF AR
71603-5081
US

V. Phone/Fax

Practice location:
  • Phone: 870-671-4914
  • Fax: 870-671-4917
Mailing address:
  • Phone: 870-671-4914
  • Fax: 870-671-4917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20708
License Number StateAR

VIII. Authorized Official

Name: FLOYD STICE
Title or Position: PHARMACIST OWNER
Credential:
Phone: 501-442-4657