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General NPI Number Information
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NPI Number | 1750859195
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE RX LLC
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Dates
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Enumeration Date | 11/03/2018
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 1606 MARTIN LUTHER KING BLVD
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City | MALVERN
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State | AR
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Zip | 72104-2006
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Country | US
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Telephone | 501-229-1446
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Fax | 501-229-1397
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Provider Business Mailing Address
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Address Line | 1606 MARTIN LUTHER KING BLVD
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City | MALVERN
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State | AR
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Zip | 72104-2006
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Country | US
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Telephone | 501-229-1446
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Fax | 501-229-1397
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Authorized Official
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Title or Position | PHARMACIST
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Name | MRS. SHELYN Y DAVIS
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Credential | PHARMD
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Telephone | 501-844-1785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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