Healthcare Provider Details

I. General information

NPI: 1588932578
Provider Name (Legal Business Name): PARIS FAMILY PHARMAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 E WALNUT ST
PARIS AR
72855-4125
US

IV. Provider business mailing address

1211 E WALNUT ST P.O. BOX 648
PARIS AR
72855-4125
US

V. Phone/Fax

Practice location:
  • Phone: 479-963-6400
  • Fax: 479-963-2103
Mailing address:
  • Phone: 479-963-6400
  • Fax: 479-963-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR13170
License Number StateAR

VIII. Authorized Official

Name: LEE ROY PARKER
Title or Position: PRESIDENT
Credential: PD
Phone: 479-963-6400