Organization
SOUTHSIDE SPECIALTY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IHAB HERRAKA (MD/OWNER)
(479) 242-2888
Entity
Organization
Contact information
Practice address
3416 OLD GREENWOOD RD, SUITE A, FORT SMITH, AR 72903-5462
(479) 242-2888
Mailing address
3416 OLD GREENWOOD RD, SUITE A, FORT SMITH, AR 72903-5462
Taxonomy
Speciality
Code
Description
License number
State
3336S0011X
Specialty Pharmacy
Primary
AR20829
AR
Other
Enumeration date
02/22/2016
Last updated
02/22/2016
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