Provider Demographics
NPI:1043990617
Name:CONWAY APOTHECARY INC.
Entity Type:Organization
Organization Name:CONWAY APOTHECARY INC.
Other - Org Name:CONWAY APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:870-540-7955
Mailing Address - Street 1:2225 ELDRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5018
Mailing Address - Country:US
Mailing Address - Phone:870-540-7955
Mailing Address - Fax:
Practice Address - Street 1:2125 COLLEGE AVE STE 1
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6387
Practice Address - Country:US
Practice Address - Phone:501-327-8088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy