Healthcare Provider Details

I. General information

NPI: 1780665034
Provider Name (Legal Business Name): MITCHELLS PARK STREET PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 PARK ST
CALICO ROCK AR
72519-9070
US

IV. Provider business mailing address

PO BOX 569
CALICO ROCK AR
72519-0569
US

V. Phone/Fax

Practice location:
  • Phone: 870-297-8107
  • Fax: 870-297-8799
Mailing address:
  • Phone: 870-297-8107
  • Fax: 870-297-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SARAH BETH MITCHELL
Title or Position: PRESIDENT
Credential: PHARM D
Phone: 870-297-8107