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General NPI Number Information
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NPI Number | 1245035260
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Entity Type | Organization
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Legal Business Name | WEST SIDE PHARMACY- MILITARY ROAD LLC
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 1525 MILITARY ROAD
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City | BENTON
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State | AR
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Zip | 72015
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Country | US
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Telephone | 501-778-3151
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Fax |
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Provider Business Mailing Address
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Address Line | 620 W SOUTH ST
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City | BENTON
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State | AR
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Zip | 72015-4258
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Country | US
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Telephone | 501-778-3151
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Fax | 501-778-7329
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Authorized Official
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Title or Position | OWNER
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Name | DR. MADDISON SCHULLER
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Credential | PHARMD
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Telephone | 501-778-3151
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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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