Organization
FOUNTAIN LAKE FAMILY PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BUTLER (PRESIDENT)
(501) 547-3400
Entity
Organization
Contact information
Practice address
4517 PARK AVE, HOT SPRINGS, AR 71901
(501) 547-3400
(501) 521-1033
Mailing address
4517 PARK AVE, HOT SPRINGS, AR 71901
(501) 547-3400
(501) 521-1033
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236424407
—
AR
Enumeration date
07/19/2023
Last updated
07/19/2023
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