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General NPI Number Information
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NPI Number | 1811026156
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Entity Type | Organization
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Legal Business Name | FAMILY CLINIC PHARMACY, LLC
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Dates
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Enumeration Date | 03/04/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1208 W MAIN ST
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City | WALNUT RIDGE
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State | AR
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Zip | 72476-1005
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Country | US
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Telephone | 870-886-8100
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Fax | 870-886-9200
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Provider Business Mailing Address
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Address Line | 1208 W MAIN ST
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City | WALNUT RIDGE
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State | AR
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Zip | 72476-1005
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Country | US
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Telephone | 870-886-8100
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Fax | 870-886-9200
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. VAN ALLEN CLAYTON
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Credential | PHARM.D.
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Telephone | 870-886-8100
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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 | 0420272
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License Number State | AR
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