Healthcare Provider Details

I. General information

NPI: 1477547362
Provider Name (Legal Business Name): WPM COMMUNITY PHARMACIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N WEST AVE
EL DORADO AR
71730-4655
US

IV. Provider business mailing address

PO BOX 524
ARKADELPHIA AR
71923-6024
US

V. Phone/Fax

Practice location:
  • Phone: 870-863-8111
  • Fax: 870-863-4104
Mailing address:
  • Phone: 870-403-9400
  • Fax: 870-245-1790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberAR02571
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR02571
License Number StateAR

VIII. Authorized Official

Name: AMBER HAYCOX
Title or Position: VP OF REVENUE OPERATIONS
Credential:
Phone: 870-403-9400