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General NPI Number Information
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NPI Number | 1922375559
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Entity Type | Organization
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Legal Business Name | MEDI SHOP PHARMACY
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 03/17/2017
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Provider Practice Location Address
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Address Line | 204 HIGHWAY 71 S
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City | MENA
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State | AR
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Zip | 71953-4638
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Country | US
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Telephone | 479-394-3254
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Fax | 479-394-0235
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Provider Business Mailing Address
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Address Line | 204 HIGHWAY 71 S
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City | MENA
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State | AR
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Zip | 71953-4638
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Country | US
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Telephone | 479-394-3254
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Fax | 479-394-0235
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Authorized Official
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Title or Position | PHARMACIST
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Name | ROBERT GEYER
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Credential | PHARM.D.
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Telephone | 479-394-7476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | AR20383
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License Number State | AR
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