Provider Demographics
NPI:1497818967
Name:BUNDY FAMILY PHARMACY LLC
Entity type:Organization
Organization Name:BUNDY FAMILY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-741-2119
Mailing Address - Street 1:731 N MAIN ST., SUITE B
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601
Mailing Address - Country:US
Mailing Address - Phone:870-741-2119
Mailing Address - Fax:870-741-5572
Practice Address - Street 1:731 N MAIN ST., SUITE B
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601
Practice Address - Country:US
Practice Address - Phone:870-741-2119
Practice Address - Fax:870-741-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143606407Medicaid
AR1218400001Medicare ID - Type Unspecified
AR143606407Medicaid