Organization
MAYBRANCH PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON RAY MUTTERS (PHARMACIST)
(479) 646-3434
Entity
Organization
Contact information
Practice address
2801 OLD GREENWOOD RD, STE. 11, FORT SMITH, AR 72903-4560
(479) 646-3434
Mailing address
2801 OLD GREENWOOD RD, STE. 11, FORT SMITH, AR 72903-4560
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
AR20274
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0409993
NCPDP
—
Enumeration date
09/27/2005
Last updated
08/22/2020
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