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General NPI Number Information
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NPI Number | 1659619120
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Entity Type | Organization
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Legal Business Name | CONWAY MEDCARE PHARMACY, LLC
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 2521 COLLEGE AVE
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City | CONWAY
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State | AR
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Zip | 72034-6135
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Country | US
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Telephone | 501-358-3498
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Fax | 501-358-3506
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Provider Business Mailing Address
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Address Line | PO BOX 878
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City | CONWAY
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State | AR
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Zip | 72033-0878
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Country | US
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Telephone | 501-358-3498
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Fax | 501-358-3506
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. MATTHEW THOMAS FRAZIER
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Credential | PHARMD
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Telephone | 501-472-7980
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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 | AR20700
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License Number State | AR
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