Healthcare Provider Details

I. General information

NPI: 1790141216
Provider Name (Legal Business Name): PREMIER PHARMACY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 E HENRI DE TONTI BLVD
SPRINGDALE AR
72762-4124
US

IV. Provider business mailing address

834 E HENRI DE TONTI BLVD
SPRINGDALE AR
72762
US

V. Phone/Fax

Practice location:
  • Phone: 501-813-5971
  • Fax: 501-992-1013
Mailing address:
  • Phone: 501-813-5971
  • 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 NumberAR20822
License Number StateAR

VIII. Authorized Official

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