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General NPI Number Information
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NPI Number | 1689670457
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Entity Type | Organization
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Legal Business Name | AMYCO INC
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 700 LEXINGTON AVE
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City | FORT SMITH
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State | AR
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Zip | 72901-4738
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Country | US
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Telephone | 479-782-2881
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Fax | 479-782-3974
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Provider Business Mailing Address
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Address Line | 700 LEXINGTON AVE
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City | FORT SMITH
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State | AR
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Zip | 72901-4738
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Country | US
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Telephone | 479-782-2881
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Fax | 479-782-3974
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Authorized Official
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Title or Position | OWNER
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Name | MS. KANDICE AMY GIBBONS
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Credential | PHARM.D.
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Telephone | 479-782-2881
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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 | 72669
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License Number State | AR
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