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General NPI Number Information
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NPI Number | 1770055923
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Entity Type | Organization
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Legal Business Name | GOSNELL DRUGS INC.
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Dates
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Enumeration Date | 12/28/2018
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 134 BEVILL AVE
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City | GOSNELL
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State | AR
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Zip | 72315
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Country | US
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Telephone | 573-559-5525
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Fax |
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Provider Business Mailing Address
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Address Line | 134 BEVILL AVE
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City | GOSNELL
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State | AR
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Zip | 72315
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Country | US
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Telephone | 870-751-9242
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Fax | 870-751-9291
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Authorized Official
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Title or Position | OWNER
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Name | TYSON WALLACE
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Credential |
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Telephone | 870-751-9242
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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 |
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License Number State |
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