MEDICARE: POKE 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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1699788547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POKE PHARMACY INC

Provider Business Mailing Address
First Line	:	4 S POPLAR ST
Second Line	:
City	:	MARIANNA
State	:	AR
Zip	:	72360-2320
Country	:	US
Telephone Number	:	870-295-3441
Fax Number	:	870-298-2635

Provider Business Practice Location Address
First Line	:	4 S POPLAR ST
Second Line	:
City	:	MARIANNA
State	:	AR
Zip	:	72360-2320
Country	:	US
Telephone Number	:	870-295-3441
Fax Number	:	870-298-2635

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT POKE
Credential	:	RPH
Telephone Number	:	870-295-3441

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	08/14/2008

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Directions to “POKE PHARMACY INC ” Practice Location

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