Provider Demographics
NPI:1235358011
Name:MEDICAL ARTS PHARMACY
Entity Type:Organization
Organization Name:MEDICAL ARTS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-886-6251
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:1219 W. MAIN
Mailing Address - City:WALNUT RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72476-0008
Mailing Address - Country:US
Mailing Address - Phone:870-886-6251
Mailing Address - Fax:870-886-5560
Practice Address - Street 1:1219 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72476-1003
Practice Address - Country:US
Practice Address - Phone:870-886-6251
Practice Address - Fax:870-886-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR06404183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0406404OtherNABP NUMBER