=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518065549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARAGOULD PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 10/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 W KINGSHIGHWAY STE 3
-----------------------------------------------------
City | PARAGOULD
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72450-2601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-215-5255
-----------------------------------------------------
Fax | 870-215-5257
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 W KINGSHIGHWAY STE 3
-----------------------------------------------------
City | PARAGOULD
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72450-2601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-215-5255
-----------------------------------------------------
Fax | 870-215-5257
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PHARMACIST
-----------------------------------------------------
Name | CHAD REGISTER
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 871-215-2522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | AR20372
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------