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General NPI Number Information
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NPI Number | 1275994501
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Entity Type | Organization
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Legal Business Name | CW FAMILY PHARMACY
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Dates
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Enumeration Date | 03/15/2016
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Last Update Date | 03/15/2016
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Provider Practice Location Address
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Address Line | 210 E BROADWAY
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City | GLENWOOD
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State | AR
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Zip | 71943-9243
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Country | US
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Telephone | 870-356-2194
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Fax |
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Provider Business Mailing Address
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Address Line | 210 E BROADWAY
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City | GLENWOOD
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State | AR
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Zip | 71943-9243
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Country | US
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Telephone | 870-356-2194
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA LYNN WAGNER
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Credential |
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Telephone | 479-243-6169
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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 | AR16289
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License Number State | AR
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