MEDICARE: V & K PRN, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	008789	AR

General Provider Information

NPI Number	:	1356329650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	V & K PRN, INC

Provider Business Mailing Address
First Line	:	PO BOX 7
Second Line	:
City	:	MAMMOTH SPRING
State	:	AR
Zip	:	72554-0007
Country	:	US
Telephone Number	:	870-625-3222
Fax Number	:	870-625-3216

Provider Business Practice Location Address
First Line	:	270 MAIN STREET,
Second Line	:
City	:	MAMMOTH SPRING
State	:	AR
Zip	:	72554
Country	:	US
Telephone Number	:	870-625-3222
Fax Number	:	870-625-3216

Authorized Official
Title or Position	:	OWNNER
Name	:	MRS. VICKI CLAYTON FOWLKES
Credential	:	PHARMACIST
Telephone Number	:	870-625-3222

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	08/22/2020

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Directions to “V & K PRN, INC ” Practice Location

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