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NPI Code Detail

MEDICARE: AMYCO INC

MEDICARE: AMYCO 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
1333600000XPharmacy72669AR

Other Identifiers

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

General Provider Information

NPI Number : 1689670457
Entity Type Code : Organization
Provider Name (Legal Business Name) : AMYCO INC
Provider Business Mailing Address
First Line : 700 LEXINGTON AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-4738
Country : US
Telephone Number : 479-782-2881
Fax Number : 479-782-3974
Provider Business Practice Location Address
First Line : 700 LEXINGTON AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-4738
Country : US
Telephone Number : 479-782-2881
Fax Number : 479-782-3974
Authorized Official
Title or Position : OWNER
Name : MS. KANDICE AMY GIBBONS
Credential : PHARM.D.
Telephone Number : 479-782-2881
Provider Enumeration Date : 06/24/2005
Last Update Date : 08/22/2020

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Directions to “AMYCO INC ” Practice Location

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