Healthcare Provider Details

I. General information

NPI: 1679568729
Provider Name (Legal Business Name): ECONO-MART PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 HARRISON ST
BATESVILLE AR
72501-7222
US

IV. Provider business mailing address

1595 HARRISON ST
BATESVILLE AR
72501-7222
US

V. Phone/Fax

Practice location:
  • Phone: 870-793-4179
  • Fax: 870-793-7303
Mailing address:
  • Phone: 870-793-4179
  • Fax: 870-793-7303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR14083
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAUL HOLIFIELD
Title or Position: OWNER
Credential: PHARMD
Phone: 870-793-4179