Healthcare Provider Details

I. General information

NPI: 1639260474
Provider Name (Legal Business Name): POLK PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 S POPLAR ST
MARIANNA AR
72360-2320
US

IV. Provider business mailing address

4 S POPLAR ST
MARIANNA AR
72360-2320
US

V. Phone/Fax

Practice location:
  • Phone: 870-295-3441
  • Fax: 870-298-2635
Mailing address:
  • Phone: 870-295-3441
  • Fax: 870-298-2635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SCOTT POLK
Title or Position: PRESIDENT
Credential:
Phone: 870-295-3441