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NPI Code Detail

MEDICARE: WYNNE MEDICAL PHARMACY INC

MEDICARE: WYNNE MEDICAL PHARMACY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail PharmacyAR06581AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10406581OTHERNABP NCPDP

General Provider Information

NPI Number : 1457332850
Entity Type Code : Organization
Provider Name (Legal Business Name) : WYNNE MEDICAL PHARMACY INC
Provider Business Mailing Address
First Line : PO BOX 757
Second Line :
City : WYNNE
State : AR
Zip : 72396-0757
Country : US
Telephone Number : 870-238-8531
Fax Number : 870-238-5982
Provider Business Practice Location Address
First Line : 718 FALLS BLVD S
Second Line :
City : WYNNE
State : AR
Zip : 72396-3514
Country : US
Telephone Number : 870-238-8531
Fax Number : 870-238-5982
Authorized Official
Title or Position : CEO
Name : STEPHANIE GOODART ONEAL
Credential : PD
Telephone Number : 870-238-8531
Provider Enumeration Date : 11/11/2005
Last Update Date : 09/11/2025

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Directions to “WYNNE MEDICAL PHARMACY INC ” Practice Location

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