Organization
NIC-HIL INC
Active
Other names
MEDICAP PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY BOX RPH (OWNER PHARMACIST)
(479) 571-4545
Entity
Organization
Contact information
Practice address
2818 W MARTIN LUTHER KING BLVD, FAYETTEVILLE, AR 72704-7625
(479) 571-4545
(479) 571-4050
Mailing address
2818 W MARTIN LUTHER KING BLVD, FAYETTEVILLE, AR 72704-7625
(479) 571-4545
(479) 571-4050
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
0420120
AR
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0420199
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
134268407
—
AR
05
—
13507716
—
AR
Enumeration date
11/15/2006
Last updated
03/07/2023
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