MEDICARE: LAWS VILLAGE PHARMACY, 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	AR-14576	AR

General Provider Information

NPI Number	:	1417942731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWS VILLAGE PHARMACY, INC.

Provider Business Mailing Address
First Line	:	2504 MARKET TRCE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8676
Country	:	US
Telephone Number	:	479-646-5505
Fax Number	:	479-649-7535

Provider Business Practice Location Address
First Line	:	2504 MARKET TRCE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8676
Country	:	US
Telephone Number	:	479-646-5505
Fax Number	:	479-649-7535

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSEPH KORKAMES
Credential	:	R.PH
Telephone Number	:	479-646-5505

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	08/22/2020

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