Healthcare Provider Details

I. General information

NPI: 1154606614
Provider Name (Legal Business Name): BRYAN SCOTT POLLOCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CHURCH ST
HARDY AR
72542-8827
US

IV. Provider business mailing address

101 CHURCH ST
HARDY AR
72542-8827
US

V. Phone/Fax

Practice location:
  • Phone: 870-856-2890
  • Fax: 870-856-2891
Mailing address:
  • Phone: 870-856-2890
  • Fax: 870-856-2891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20664
License Number StateAR

VIII. Authorized Official

Name: BRYAN POLLOCK
Title or Position: OWNER/PIC
Credential:
Phone: 870-856-2890