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General NPI Number Information
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NPI Number | 1326546524
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Entity Type | Organization
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Legal Business Name | WHITE RIVER PHARMACY, LLC
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 7321 W SUNSET AVE STE G
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City | SPRINGDALE
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State | AR
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Zip | 72762-0990
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Country | US
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Telephone | 479-777-7018
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Fax |
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Provider Business Mailing Address
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Address Line | 7321 W SUNSET AVE STE G
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City | SPRINGDALE
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State | AR
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Zip | 72762-0990
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Country | US
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Telephone | 479-777-7018
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ITALO SOLARI
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Credential |
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Telephone | 479-777-7018
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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 | AR20870
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License Number State | AR
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