Healthcare Provider Details

I. General information

NPI: 1982958484
Provider Name (Legal Business Name): POTTSVILLE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5395 W ASH ST SUITE 9
POTTSVILLE AR
72858-9170
US

IV. Provider business mailing address

PO BOX 299
POTTSVILLE AR
72858-0299
US

V. Phone/Fax

Practice location:
  • Phone: 479-498-4130
  • Fax: 479-498-4133
Mailing address:
  • Phone: 479-498-4130
  • Fax: 479-498-4133

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: CLINTON BELL
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 479-498-4130