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General NPI Number Information
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NPI Number | 1841336765
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Entity Type | Organization
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Legal Business Name | BELLA VISTA PHARMACY, INC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 408 TOWN CTR NE
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City | BELLA VISTA
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State | AR
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Zip | 72714-1817
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Country | US
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Telephone | 479-855-3791
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Fax | 479-876-5881
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Provider Business Mailing Address
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Address Line | 408 TOWN CTR NE
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City | BELLA VISTA
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State | AR
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Zip | 72714-1817
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Country | US
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Telephone | 479-855-3791
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Fax | 479-876-5881
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Authorized Official
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Title or Position | TREASURER, PHARMTECH
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Name | MR. TANNER B BEDWELL
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Credential |
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Telephone | 479-855-3791
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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 | AR11950
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License Number State | AR
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