MEDICARE: HEALTHCARE 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	3336S0011X	Specialty Pharmacy
2	3336L0003X	Long Term Care 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	:	1760470520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHCARE PHARMACY, INC.

Provider Business Mailing Address
First Line	:	3401 ATWOOD RD
Second Line	:	SUITE F
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-6012
Country	:	US
Telephone Number	:	501-888-7514
Fax Number	:	501-888-7504

Provider Business Practice Location Address
First Line	:	3401 ATWOOD RD
Second Line	:	SUITE F
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-6012
Country	:	US
Telephone Number	:	501-888-7514
Fax Number	:	501-888-7504

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JERRY B STEPHENS
Credential	:	RPH
Telephone Number	:	501-888-7514

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	01/22/2019

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