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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