Provider Demographics
NPI:1043386964
Name:MICROGNOSTICS, INC.
Entity Type:Organization
Organization Name:MICROGNOSTICS, INC.
Other - Org Name:PLAINVIEW CORNER DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEARING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-272-4291
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72857-0217
Mailing Address - Country:US
Mailing Address - Phone:479-272-4291
Mailing Address - Fax:
Practice Address - Street 1:102 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:AR
Practice Address - Zip Code:72857
Practice Address - Country:US
Practice Address - Phone:479-272-4291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICROGNOSTICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-24
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0419158OtherNCPDP
AR128123407Medicaid