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General NPI Number Information
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NPI Number | 1770685083
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Entity Type | Individual
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Provider Name | MARY CAROLE M POLK RPH
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Gender | Female
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 333 MADISON STREET
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City | CLARENDON
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State | AR
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Zip | 72029
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Country | US
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Telephone | 870-747-3304
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Fax |
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Provider Business Mailing Address
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Address Line | 55 NORMANDY LN
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City | LITTLE ROCK
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State | AR
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Zip | 72207-4201
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Country | US
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Telephone | 501-690-7519
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 7925
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License Number State | AR
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