Provider Demographics
NPI:1366706244
Name:ALLCARE SPECIALTY PHARMACY LLC
Entity type:Organization
Organization Name:ALLCARE SPECIALTY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-403-9400
Mailing Address - Street 1:10620 COLONEL GLENN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-8048
Mailing Address - Country:US
Mailing Address - Phone:877-420-9400
Mailing Address - Fax:501-217-8885
Practice Address - Street 1:10620 COLONEL GLENN RD STE 300
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-8048
Practice Address - Country:US
Practice Address - Phone:501-217-8880
Practice Address - Fax:501-217-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA46753336C0003X
IL054.0200093336C0003X
HIPMP12793336C0003X
KYAR21573336C0003X
FLPH299843336C0003X
KS22-450893336C0003X
CTPCN.00030973336C0003X
ID41734MS3336C0003X
COOSP.00068313336C0003X
IN64002098A3336C0003X
GAPHNR0009593336C0003X
LAPHY.007361-NR3336C0003X
DEA9-00019283336C0003X
DCNRX18013113336C0003X
AK1127703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135880OtherPK
AR7549110001Medicare NSC