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General NPI Number Information
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NPI Number | 1235110644
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Entity Type | Organization
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Legal Business Name | MEDIC PHARMACY INC OF EL DORADO
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Dates
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Enumeration Date | 11/11/2005
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 347 W OAK STREET
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City | EL DORADO
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State | AR
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Zip | 71730-4521
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Country | US
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Telephone | 870-862-4931
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Fax | 870-862-6659
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Provider Business Mailing Address
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Address Line | 347 W OAK STREET
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City | EL DORADO
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State | AR
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Zip | 71730-4521
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Country | US
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Telephone | 870-862-4931
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Fax | 870-862-6659
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | MR. WILLIAM RICHARD HANRY
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Credential | RPH
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Telephone | 870-862-4931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 4623060001
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License Number State | AR
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