Healthcare Provider Details

I. General information

NPI: 1265925028
Provider Name (Legal Business Name): PHARMACY BARN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9746 HIGHWAY 62/412
VIOLA AR
72583
US

IV. Provider business mailing address

9746 HIGHWAY 62/412
VIOLA AR
72583
US

V. Phone/Fax

Practice location:
  • Phone: 870-458-2223
  • Fax:
Mailing address:
  • Phone: 870-458-2223
  • Fax:

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. ELIZABETH KAY SMITH
Title or Position: OWNER
Credential: PHARMD
Phone: 913-626-1315