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Organization

WILSON BEARDEN PHARMACY INC

Active
Other names
WILSON BEARDEN PHARMACY
Organization subpart
No

Provider details

NPI number
Authorized official
IVY MOORE PD (PHARMACIST AND OWNER)
(870) 234-1062
Entity
Organization

Contact information

Practice address
134 N WASHINGTON, MAGNOLIA, AR 71753-2856
(870) 234-1062
(870) 234-8366
Mailing address
PO BOX 597, MAGNOLIA, AR 71754-0597

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
333600000X
Pharmacy
3336C0003X
Community/Retail Pharmacy
Primary
AR10895
AR
3336L0003X
Long Term Care Pharmacy

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1994116
PK
05
210631407
AR
Enumeration date
08/10/2006
Last updated
04/12/2016
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