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General NPI Number Information
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NPI Number | 1831879451
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Entity Type | Organization
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Legal Business Name | FOUNTAIN LAKE FAMILY PHARMACY LLC
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 4517 PARK AVE
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City | HOT SPRINGS
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State | AR
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Zip | 71901
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Country | US
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Telephone | 501-547-3400
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Fax | 501-521-1033
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Provider Business Mailing Address
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Address Line | 4517 PARK AVE
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City | HOT SPRINGS
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State | AR
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Zip | 71901
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Country | US
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Telephone | 501-547-3400
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Fax | 501-521-1033
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL BUTLER
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Credential |
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Telephone | 501-547-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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