MEDICARE: DEBBIE'S FAMILY PHARMACY, INC.

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	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy	AR20204	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	2164562	OTHER		PK

General Provider Information

NPI Number	:	1487104725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBBIE'S FAMILY PHARMACY, INC.

Provider Business Mailing Address
First Line	:	5403 W PINNACLE POINTE DR
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8118
Country	:	US
Telephone Number	:	479-271-6300
Fax Number	:	479-271-6305

Provider Business Practice Location Address
First Line	:	5403 W PINNACLE POINTE DR
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8118
Country	:	US
Telephone Number	:	479-254-8900
Fax Number	:	479-254-9809

Authorized Official
Title or Position	:	PRESIDENT/PHARMACIST IN CHARGE
Name	:	DR. ANDREW MIZE
Credential	:	AO
Telephone Number	:	479-271-6300

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	10/07/2024

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