Organization
JASPER PHARMACY INC
Active
Other names
JASPER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LEAH HENDERSON PHARM D (OWNER)
(870) 446-5515
Entity
Organization
Contact information
Practice address
200 W CHURCH ST, JASPER, AR 72641-0520
(870) 446-5515
Mailing address
PO BOX 520, JASPER, AR 72641-0520
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR18637
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125725407
—
AR
01
—
1995499
PK
—
Enumeration date
08/18/2006
Last updated
02/07/2014
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