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General NPI Number Information
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NPI Number | 1164563136
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Entity Type | Organization
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Legal Business Name | MANES PHARMACY, INC
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Dates
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Enumeration Date | 02/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2215 ALMA HWY
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City | VAN BUREN
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State | AR
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Zip | 72956-5009
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Country | US
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Telephone | 479-474-5028
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Fax | 479-474-4792
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Provider Business Mailing Address
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Address Line | 2215 ALMA HWY
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City | VAN BUREN
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State | AR
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Zip | 72956-5009
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Country | US
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Telephone | 479-474-5028
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Fax | 479-474-4792
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Authorized Official
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Title or Position | MANAGER
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Name | MARK ALAN MANES
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Credential | P.D.
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Telephone | 479-474-5028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | AR15009
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License Number State | AR
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