Healthcare Provider Details

I. General information

NPI: 1073014866
Provider Name (Legal Business Name): EAST END EXPRESS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21019 HIGHWAY 167, SUITE 100
HENSLEY AR
72065
US

IV. Provider business mailing address

21019 HIGHWAY 167, SUITE 100
HENSLEY AR
72065
US

V. Phone/Fax

Practice location:
  • Phone: 501-486-4100
  • Fax: 501-486-4101
Mailing address:
  • Phone: 501-486-4100
  • Fax: 501-486-4101

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 NumberAR20875
License Number StateAR

VIII. Authorized Official

Name: DR. ERIN BRENNA GREENE
Title or Position: SECRETARY/TREASURER
Credential: PHARMD
Phone: 501-486-4100