Organization
BELLA VISTA PHARMACY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TANNER B BEDWELL (TREASURER, PHARMTECH)
(479) 855-3791
Entity
Organization
Contact information
Practice address
408 TOWN CTR NE, BELLA VISTA, AR 72714-1817
(479) 855-3791
(479) 876-5881
Mailing address
408 TOWN CTR NE, BELLA VISTA, AR 72714-1817
(479) 855-3791
(479) 876-5881
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
AR11950
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10641
PTAN
AR
Enumeration date
01/29/2007
Last updated
10/13/2009
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