1740320431 NPI number — MEDI-MART PHARMACY

Table of content: (NPI 1740320431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740320431 NPI number — MEDI-MART PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDI-MART PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LOW'S PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740320431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRINKLEY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72021-2819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-734-3161
Provider Business Mailing Address Fax Number:
870-734-1322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRINKLEY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72021-2819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-734-3161
Provider Business Practice Location Address Fax Number:
870-734-1322
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CURRY
Authorized Official First Name:
SAM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PHARMACIST & MANAGER
Authorized Official Telephone Number:
870-734-3161

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  AR16241 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AR16241 . This is a "PHARMACY LICENSE PERMIT" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com