MEDICARE: COMMUNITY CARE RX

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	261QH0100X	Health Service Clinic/Center
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1265328975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE RX

Provider Business Mailing Address
First Line	:	1606 MARTIN LUTHER KING BLVD
Second Line	:
City	:	MALVERN
State	:	AR
Zip	:	72104-2006
Country	:	US
Telephone Number	:	501-229-1446
Fax Number	:

Provider Business Practice Location Address
First Line	:	1606 MARTIN LUTHER KING BLVD
Second Line	:
City	:	MALVERN
State	:	AR
Zip	:	72104-2006
Country	:	US
Telephone Number	:	501-229-1446
Fax Number	:	501-229-1397

Authorized Official
Title or Position	:	PHARMACIST
Name	:	SAMANTHA PENNINGTON
Credential	:
Telephone Number	:	501-229-1446

Provider Enumeration Date	:	06/17/2025
Last Update Date	:	06/17/2025

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Directions to “COMMUNITY CARE RX ” Practice Location

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