Individual
MRS. MARY CAROLE M POLK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
333 MADISON STREET, CLARENDON, AR 72029
(870) 747-3304
Mailing address
55 NORMANDY LN, LITTLE ROCK, AR 72207-4201
(501) 690-7519
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
7925
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124343407
—
AR
05
—
1291951
—
LA
01
—
20-0270245
FEDERAL TAX ID
AR
01
—
281107-48-001
SALES AND USE TAX NUMBER
AR
Enumeration date
09/05/2006
Last updated
12/27/2024
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