=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306898093
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEARCY MEDICAL CENTER PHARMACY, LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 11/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 HAWKINS DR
-----------------------------------------------------
City | SEARCY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72143-4802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-268-3311
-----------------------------------------------------
Fax | 501-279-2675
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2900 HAWKINS DR
-----------------------------------------------------
City | SEARCY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72143-4802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-268-3311
-----------------------------------------------------
Fax | 501-279-2675
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER/MANAGER
-----------------------------------------------------
Name | DR. CASEY A MCLEOD
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 501-268-3311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 20354
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | AR20354
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------