Organization
MALLARD MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY REED WARDLAW ATP (MANAGER)
(870) 226-9501
Entity
Organization
Contact information
Practice address
801 E CHURCH ST, WARREN, AR 71671-3454
(870) 226-9501
(870) 226-9500
Mailing address
801 E CHURCH ST, WARREN, AR 71671-3454
(870) 226-9501
(870) 226-9500
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
14306
AR
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
14306
AR
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Enumeration date
12/13/2013
Last updated
12/13/2013
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