Provider Demographics
NPI:1326033515
Name:MEDI-MART PHARMACY INC
Entity Type:Organization
Organization Name:MEDI-MART PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:870-734-3088
Mailing Address - Street 1:1415 PINECREST SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:BRINKLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72021-2000
Mailing Address - Country:US
Mailing Address - Phone:870-734-3088
Mailing Address - Fax:870-734-1367
Practice Address - Street 1:1415 PINECREST SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:BRINKLEY
Practice Address - State:AR
Practice Address - Zip Code:72021-2000
Practice Address - Country:US
Practice Address - Phone:870-734-3088
Practice Address - Fax:870-734-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0406858333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy