Healthcare Provider Details

I. General information

NPI: 1912087446
Provider Name (Legal Business Name): NORTH PARK PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N MAPLE ST
DEQUEEN AR
71832
US

IV. Provider business mailing address

PO BOX 930
DEQUEEN AR
71832
US

V. Phone/Fax

Practice location:
  • Phone: 870-642-3784
  • Fax: 870-642-5827
Mailing address:
  • Phone: 870-642-3784
  • Fax: 870-642-5827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberAR13776
License Number StateAR

VIII. Authorized Official

Name: MR. GARY F GREENE
Title or Position: OWNER CHIEF PHARMACIST
Credential: RPH
Phone: 870-642-3784