Organization
WEST SIDE PHARMACY INCORPORATED
Active
Organization
WEST SIDE PHARMACY INCORPORATED
Active
Other names
WEST SIDE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES ZACKARY HALEY PHARMD (PHARMACIST IN CHARGE)
(501) 517-0227
Entity
Organization
Contact information
Practice address
620 WEST SOUTH STREET, BENTON, AR 72015
(501) 778-3151
(501) 778-7329
Mailing address
620 WEST SOUTH STREET, BENTON, AR 72015
(501) 778-3151
(501) 778-7329
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR01745
AR
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027989700
—
AR
01
—
0401745
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
100097407
—
AR
05
—
200054590A
—
OK
Enumeration date
07/31/2006
Last updated
12/14/2020
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