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General NPI Number Information
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NPI Number | 1740693969
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Entity Type | Organization
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Legal Business Name | ARCH STREET LTC PHARMCY LLC
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 05/03/2016
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Provider Practice Location Address
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Address Line | 607 W MAIN ST
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City | JACKSONVILLE
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State | AR
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Zip | 72076-4431
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Country | US
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Telephone | 501-475-0396
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Fax | 501-475-0398
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Provider Business Mailing Address
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Address Line | 607 W MAIN ST
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City | JACKSONVILLE
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State | AR
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Zip | 72076-4431
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Country | US
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Telephone | 501-475-0396
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Fax | 501-475-0398
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Authorized Official
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Title or Position | OWNER
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Name | MARK MCMURRY
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Credential |
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Telephone | 501-650-4709
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | AR20749
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License Number State | AR
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