Healthcare Provider Details

I. General information

NPI: 1568569309
Provider Name (Legal Business Name): BARRETT RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E MAIN ST
GREEN FOREST AR
72638-2432
US

IV. Provider business mailing address

PO BOX 1299
GREEN FOREST AR
72638-1299
US

V. Phone/Fax

Practice location:
  • Phone: 870-438-5614
  • Fax: 870-438-6256
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 NumberAR20398
License Number StateAR

VIII. Authorized Official

Name: DUSTY BARRETT
Title or Position: OWNER/PRESIDENT
Credential: PHARM D
Phone: 479-559-2183