MEDICARE: HOT SPRINGS PHARMACY, LLC

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	3336S0011X	Specialty Pharmacy	AR20658	AR
2	3336C0003X	Community/Retail Pharmacy	AR20658	AR

General Provider Information

NPI Number	:	1124313267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOT SPRINGS PHARMACY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2085
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71914-2085
Country	:	US
Telephone Number	:	501-760-2444
Fax Number	:	501-760-2449

Provider Business Practice Location Address
First Line	:	1210 AIRPORT RD
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-5334
Country	:	US
Telephone Number	:	501-760-2444
Fax Number	:	501-760-2449

Authorized Official
Title or Position	:	PIC, MANAGING PARTNER
Name	:	MS. ADUSTON STANFORD SPIVEY
Credential	:	RPH
Telephone Number	:	501-767-0573

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	10/12/2021

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