Organization
ARKANSAS LIVER AND GASTROENTEROLOGY, PA
Active
Other names
Southside Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IHAB HERRAKA M.D. (PRESIDENT)
(479) 242-2888
Entity
Organization
Contact information
Practice address
3416 OLD GREENWOOD RD STE A, FORT SMITH, AR 72903-5462
(479) 242-2888
(479) 242-2889
Mailing address
3416 OLD GREENWOOD RD STE A, FORT SMITH, AR 72903-5462
(479) 242-2888
(479) 242-2889
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
AR20829
AR
3336C0003X
Community/Retail Pharmacy
AR20829
AR
3336M0002X
Mail Order Pharmacy
AR20829
AR
Other
Enumeration date
03/18/2016
Last updated
03/18/2016
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