Provider Demographics
NPI:1306418363
Name:WALLING DRUG, LLC
Entity Type:Organization
Organization Name:WALLING DRUG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:870-232-0450
Mailing Address - Street 1:260 PUCKETT RD
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72521-9547
Mailing Address - Country:US
Mailing Address - Phone:870-232-0450
Mailing Address - Fax:870-232-0445
Practice Address - Street 1:316 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:AR
Practice Address - Zip Code:72521-9700
Practice Address - Country:US
Practice Address - Phone:870-232-0450
Practice Address - Fax:870-232-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-10
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy