Organization
PPG STORE 6 LLC
Active
Other names
Heartland Pharmacy Conway
Organization subpart
No
Provider details
NPI number
Authorized official
ZACH HOLDERFIELD (PARTNER/AO)
(870) 814-0605
Entity
Organization
Contact information
Practice address
2235 DAVE WARD DR STE 108, CONWAY, AR 72034-7040
(501) 450-0000
(501) 450-6433
Mailing address
824 SALEM RD, STE 210, CONWAY, AR 72034-4821
(501) 450-0000
(501) 450-6433
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR20873
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2174625
PK
—
Enumeration date
12/11/2017
Last updated
04/18/2018
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