Organization
BENNETT HEALTH SERVICES, INC.
Active
Other names
Fairfield Bay Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNY BOONE TREECE PHARMD (PRESIDENT, PHARMACIST)
(501) 884-3388
Entity
Organization
Contact information
Practice address
367 DAVE CREEK PKWY, FAIRFIELD BAY, AR 72088-3631
(501) 884-3388
(501) 884-3301
Mailing address
PO BOX 1223, FAIRFIELD BAY, AR 72088-1223
(501) 884-3388
(501) 884-3301
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
AR20041
AR
3336L0003X
Long Term Care Pharmacy
AR20041
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0416633
NCPDP
AR
05
—
132833407
—
AR
05
—
142981716
—
AR
01
—
AR20041
PHARMACY PERMIT
AR
Enumeration date
09/01/2005
Last updated
08/30/2022
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