Organization
ECONO-MED OF WALNUT RIDGE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRETA ISHMAEL (OWNER/AO)
(870) 856-4696
Entity
Organization
Contact information
Practice address
1045 W MAIN ST, STE B, WALNUT RIDGE, AR 72476-1004
(870) 886-5200
(870) 886-7553
Mailing address
1 CHOCTAW CTR, CHEROKEE VILLAGE, AR 72529-2701
(870) 856-4696
(870) 856-4658
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR20135
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2168755
PK
—
05
—
219073407
—
AR
Enumeration date
05/08/2017
Last updated
05/03/2018
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