Healthcare Provider Details

I. General information

NPI: 1992848493
Provider Name (Legal Business Name): MARSHALL MEDIC PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 HWY 65 NORTH
MARSHALL AR
72650
US

IV. Provider business mailing address

PO BOX 427
MARSHALL AR
72650-0427
US

V. Phone/Fax

Practice location:
  • Phone: 870-448-3614
  • Fax: 870-448-5143
Mailing address:
  • Phone: 870-448-3614
  • Fax: 870-448-5143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number19172
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberAR-19172
License Number StateAR

VIII. Authorized Official

Name: JEANIE HORTON
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM.D.
Phone: 870-448-3614