Organization
PRESCRIPTION STORE OF FORDYCE INC
Active
Other names
THE PRESCRIPTION STORE
Organization subpart
No
Provider details
NPI number
Authorized official
JON DEAN (PRESIDENT)
(870) 352-8631
Entity
Organization
Contact information
Practice address
1115 W 4TH ST, FORDYCE, AR 71742-2001
(870) 352-8631
(870) 352-8183
Mailing address
1115 W 4TH ST, FORDYCE, AR 71742-2001
(870) 352-8631
(870) 352-8183
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR14893
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0414893
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
11249907
—
AR
Enumeration date
02/07/2007
Last updated
02/16/2012
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