=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427493659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A & H ENTERPRISES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2013
-----------------------------------------------------
Last Update Date | 03/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3644 W STATE HIGHWAY 18
-----------------------------------------------------
City | MANILA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72442-8143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-561-1500
-----------------------------------------------------
Fax | 870-561-1501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1109
-----------------------------------------------------
City | MANILA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72442-1109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-561-1500
-----------------------------------------------------
Fax | 870-561-1501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST/PRESIDENT
-----------------------------------------------------
Name | DR. ASHLEY MASSEY
-----------------------------------------------------
Credential | PHARM. D.
-----------------------------------------------------
Telephone | 573-718-5043
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | AR20712
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------