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General NPI Number Information
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NPI Number | 1295752376
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Entity Type | Organization
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Legal Business Name | MARVELL CLINIC PHARMACY, INC.
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 406 S MILL ST
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City | MARVEL
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State | AR
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Zip | 72366-0217
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Country | US
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Telephone | 870-829-1044
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Fax | 870-829-1067
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Provider Business Mailing Address
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Address Line | PO BOX 217 406 S. MILL ST
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City | MARVELL
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State | AR
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Zip | 72366-0217
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Country | US
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Telephone | 870-829-1044
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Fax | 870-829-1067
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Authorized Official
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Title or Position | OWNER PHARM
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Name | MR. JOHN WILLIAM GRAY
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Credential | PHARMACIST
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Telephone | 870-829-1044
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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 | AR20373
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | AR20373
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License Number State | AR
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