# FOUNTAIN LAKE FAMILY PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831879451
- **Authorized official:** MICHAEL BUTLER (PRESIDENT)
- **Authorized official phone:** (501) 547-3400

## Contact information

- **Practice address:** 4517 PARK AVE, HOT SPRINGS, AR 71901
- **Practice address phone:** (501) 547-3400
- **Practice address fax:** (501) 521-1033
- **Mailing address:** 4517 PARK AVE, HOT SPRINGS, AR 71901
- **Mailing address phone:** (501) 547-3400
- **Mailing address fax:** (501) 521-1033

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 07/19/2023
- **Last updated:** 07/19/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 236424407 | — | AR |