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General NPI Number Information
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NPI Number | 1841286572
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Entity Type | Organization
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Legal Business Name | MAYBRANCH PHARMACY
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2801 OLD GREENWOOD RD STE. 11
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City | FORT SMITH
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State | AR
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Zip | 72903-4560
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Country | US
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Telephone | 479-646-3434
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 OLD GREENWOOD RD STE. 11
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City | FORT SMITH
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State | AR
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Zip | 72903-4560
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | GORDON RAY MUTTERS
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Credential |
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Telephone | 479-646-3434
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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 | AR20274
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License Number State | AR
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