Healthcare Provider Details

I. General information

NPI: 1184625808
Provider Name (Legal Business Name): ASH FLAT PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 D ASH FLAT DRIVE
ASH FLAT AR
72513
US

IV. Provider business mailing address

PO BOX 278
ASH FLAT AR
72513
US

V. Phone/Fax

Practice location:
  • Phone: 870-994-7377
  • Fax: 870-994-7399
Mailing address:
  • Phone: 870-994-7377
  • Fax: 870-994-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberAR-01531
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: AUSTIN GILBREATH
Title or Position: OWNER/PHARMACIST
Credential: PHARMD
Phone: 870-994-7377