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General NPI Number Information
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NPI Number | 1023745775
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Entity Type | Organization
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Legal Business Name | DANVILLE PHARMACY LLC
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 104 E 8TH ST
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City | DANVILLE
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State | AR
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Zip | 72833-8823
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Country | US
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Telephone | 479-495-3333
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Fax | 479-495-4318
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Provider Business Mailing Address
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Address Line | 104 EAST 8TH STREET
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City | DANVILLE
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State | AR
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Zip | 72833
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Country | US
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Telephone | 479-495-3333
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Fax | 479-495-4318
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Authorized Official
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Title or Position | PIC
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Name | CLAYTON DICKERSON
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Credential |
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Telephone | 870-540-7955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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