=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922680677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARROUTHRX
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2021
-----------------------------------------------------
Last Update Date | 06/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 ADAM BROWN RD STE D
-----------------------------------------------------
City | PEARCY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71964-9505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-521-1500
-----------------------------------------------------
Fax | 501-521-2500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 146 CANYON CREEK CT
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913-8868
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHARMACIST
-----------------------------------------------------
Name | ERIC CARROUTH
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 501-282-9997
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------