Healthcare Provider Details

I. General information

NPI: 1932332103
Provider Name (Legal Business Name): CLINIC HEALTH CARE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HOSPITAL DR
MORRILTON AR
72110-4510
US

IV. Provider business mailing address

10 HOSPITAL DR
MORRILTON AR
72110-4510
US

V. Phone/Fax

Practice location:
  • Phone: 501-354-1460
  • Fax: 501-354-9724
Mailing address:
  • Phone: 501-354-1460
  • Fax: 501-354-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAK12344
License Number StateAR

VIII. Authorized Official

Name: MR. JIM RIEDMUELLER
Title or Position: OWNER
Credential:
Phone: 501-354-1460