Healthcare Provider Details

I. General information

NPI: 1487641056
Provider Name (Legal Business Name): DOLORES' FAMILY PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 E CHURCH ST
WARREN AR
71671-3509
US

IV. Provider business mailing address

1008 E CHURCH ST
WARREN AR
71671-3509
US

V. Phone/Fax

Practice location:
  • Phone: 870-226-9800
  • Fax: 870-226-9834
Mailing address:
  • Phone: 870-226-9800
  • Fax: 870-226-9834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0417801
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. DOLORES L JONES
Title or Position: PHARMACIST
Credential: RPH
Phone: 870-226-9800