Healthcare Provider Details

I. General information

NPI: 1538529508
Provider Name (Legal Business Name): HEALTH-WISE PHARMACY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E HOWARD ST
MANSFIELD AR
72944-3411
US

IV. Provider business mailing address

PO BOX 347
MANSFIELD AR
72944-0347
US

V. Phone/Fax

Practice location:
  • Phone: 479-928-4499
  • Fax: 479-928-0124
Mailing address:
  • Phone: 479-928-4499
  • Fax: 479-928-0124

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 NumberAR20831
License Number StateAR

VIII. Authorized Official

Name: RICHARD PARKS
Title or Position: PRESIDENT OF PLLC
Credential:
Phone: 479-674-2222