Provider Demographics
NPI:1326546524
Name:WHITE RIVER PHARMACY, LLC
Entity Type:Organization
Organization Name:WHITE RIVER PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ITALO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-777-7018
Mailing Address - Street 1:7321 W SUNSET AVE STE G
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0990
Mailing Address - Country:US
Mailing Address - Phone:479-777-7018
Mailing Address - Fax:
Practice Address - Street 1:7321 W SUNSET AVE STE G
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0990
Practice Address - Country:US
Practice Address - Phone:479-777-7018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR20870333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy