Provider Demographics
NPI:1356329650
Name:V & K PRN, INC
Entity Type:Organization
Organization Name:V & K PRN, INC
Other - Org Name:PALACE DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:FOWLKES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:870-625-3222
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH SPRING
Mailing Address - State:AR
Mailing Address - Zip Code:72554-0007
Mailing Address - Country:US
Mailing Address - Phone:870-625-3222
Mailing Address - Fax:870-625-3216
Practice Address - Street 1:270 MAIN STREET,
Practice Address - Street 2:
Practice Address - City:MAMMOTH SPRING
Practice Address - State:AR
Practice Address - Zip Code:72554
Practice Address - Country:US
Practice Address - Phone:870-625-3222
Practice Address - Fax:870-625-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR008789333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy