Healthcare Provider Details

I. General information

NPI: 1356455323
Provider Name (Legal Business Name): JASPER PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W CHURCH ST
JASPER AR
72641-0520
US

IV. Provider business mailing address

PO BOX 520
JASPER AR
72641-0520
US

V. Phone/Fax

Practice location:
  • Phone: 870-446-5515
  • Fax:
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 NumberAR18637
License Number StateAR

VIII. Authorized Official

Name: LEAH HENDERSON
Title or Position: OWNER
Credential: PHARM D
Phone: 870-446-5515