Healthcare Provider Details

I. General information

NPI: 1922620483
Provider Name (Legal Business Name): EAST ARKANSAS FAMILY HEALTH CENTER PHARMACY NO. 3, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 S MILL ST
MARVELL AR
72366-7236
US

IV. Provider business mailing address

900 N 7TH ST
WEST MEMPHIS AR
72301-2001
US

V. Phone/Fax

Practice location:
  • Phone: 870-829-1168
  • Fax: 870-829-1152
Mailing address:
  • Phone: 870-733-6341
  • Fax: 870-394-9541

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: DR. SUSAN WARD-JONES
Title or Position: CEO
Credential: MD
Phone: 870-735-3842