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General NPI Number Information
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NPI Number | 1417908849
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Entity Type | Organization
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Legal Business Name | JIMMMYS PHARMACY
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1704 ST A WHY 69 BLVD
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City | TRUMANN
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State | AR
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Zip | 72472
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Country | US
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Telephone | 870-483-0400
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Fax | 870-483-0409
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Provider Business Mailing Address
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Address Line | 1704 ST A WHY 69 BLVD
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City | TRUMANN
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State | AR
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Zip | 72472
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES PRESTIDGE
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Credential | RPH
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Telephone | 870-483-0400
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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 | AR20532
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License Number State | AR
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