Provider Demographics
NPI:1306832225
Name:CITY PHARMACY OF SPRINGDALE INC
Entity Type:Organization
Organization Name:CITY PHARMACY OF SPRINGDALE INC
Other - Org Name:CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:II
Authorized Official - Credentials:DP
Authorized Official - Phone:479-751-2072
Mailing Address - Street 1:701 S THOMPSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4248
Mailing Address - Country:US
Mailing Address - Phone:479-751-2072
Mailing Address - Fax:479-751-2341
Practice Address - Street 1:701 S THOMPSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4248
Practice Address - Country:US
Practice Address - Phone:479-751-2072
Practice Address - Fax:479-751-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06-149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1285440001Medicare ID - Type Unspecified