MEDICARE: JUNCTION CITY PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	AR18106	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003943770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUNCTION CITY PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 780
Second Line	:
City	:	JUNCTION CITY
State	:	AR
Zip	:	71749-0780
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 MAIN
Second Line	:
City	:	JUNCTION CITY
State	:	AR
Zip	:	71749
Country	:	US
Telephone Number	:	870-924-4018
Fax Number	:	870-924-4021

Authorized Official
Title or Position	:	OWNERPHARMACIST
Name	:	PRESTON LEON HINES
Credential	:	PD
Telephone Number	:	870-924-4018

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/30/2008

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Directions to “JUNCTION CITY PHARMACY ” Practice Location

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