Healthcare Provider Details

I. General information

NPI: 1407842404
Provider Name (Legal Business Name): MARKET STREET PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 MARKET ST
HORSESHOE BEND AR
72512-3871
US

IV. Provider business mailing address

404 MARKET ST
HORSESHOE BEND AR
72512-3871
US

V. Phone/Fax

Practice location:
  • Phone: 870-670-5098
  • Fax: 870-670-5905
Mailing address:
  • Phone: 870-670-5098
  • Fax: 870-670-5905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberAR-16253
License Number StateAR

VIII. Authorized Official

Name: DR. STEVEN JEFF MONTGOMERY
Title or Position: PHARMACIST
Credential: P.D.
Phone: 870-670-5098