Organization
MEDIPHARM INC
Active
Other names
MediPharm Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHIEMEZIE OTI (PHARMACY DIRECTOR)
(870) 394-4209
Entity
Organization
Contact information
Practice address
125 W POLK AVE, WEST MEMPHIS, AR 72301-4264
(870) 394-4209
(901) 382-9966
Mailing address
125 W POLK AVE, WEST MEMPHIS, AR 72301-4264
(870) 394-4209
(901) 382-9966
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
20617
AR
3336C0004X
Compounding Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0423311
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/14/2009
Last updated
02/10/2010
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