MEDICARE: COMMUNITY CARE RX 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	3336C0003X	Community/Retail Pharmacy

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

General Provider Information

NPI Number	:	1750859195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE RX LLC

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	:	501-229-1397

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	:	MRS. SHELYN Y DAVIS
Credential	:	PHARMD
Telephone Number	:	501-844-1785

Provider Enumeration Date	:	11/03/2018
Last Update Date	:	01/11/2021

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Directions to “COMMUNITY CARE RX LLC ” Practice Location

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