Healthcare Provider Details

I. General information

NPI: 1306985353
Provider Name (Legal Business Name): EMMANUEL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 COLLEGE AVE SUITE 1
CONWAY AR
72034-6210
US

IV. Provider business mailing address

2125 COLLEGE AVE SUITE 1
CONWAY AR
72034-6210
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-8088
  • Fax: 501-730-0220
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20149
License Number StateAR

VIII. Authorized Official

Name: ROB HARKNESS
Title or Position: VP
Credential:
Phone: 501-327-8088