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General NPI Number Information
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NPI Number | 1174624829
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Entity Type | Organization
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Legal Business Name | CARL STANLEY DUCKWORTH P A
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 218 W MAIN ST
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City | WALNUT RIDGE
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State | AR
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Zip | 72476-1933
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Country | US
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Telephone | 870-886-3461
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Fax | 870-886-3503
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Provider Business Mailing Address
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Address Line | 218 W MAIN ST PO BOX 469
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City | WALNUT RIDGE
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State | AR
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Zip | 72476-1933
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Country | US
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Telephone | 870-886-3461
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Fax | 870-886-3503
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARL DUCKWORTH
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Credential | BS PHARMACY
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Telephone | 870-886-3461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | AR15996
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License Number State | AR
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