Provider Demographics
NPI:1518956747
Name:NATIONAL PARK PHARMACY
Entity Type:Organization
Organization Name:NATIONAL PARK PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PD
Authorized Official - Phone:501-623-2280
Mailing Address - Street 1:1534 MALVERN AVE.STEB
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901
Mailing Address - Country:US
Mailing Address - Phone:501-623-2280
Mailing Address - Fax:501-624-0121
Practice Address - Street 1:1534 MALVERN AVE STE B
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6503
Practice Address - Country:US
Practice Address - Phone:501-623-2280
Practice Address - Fax:501-624-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114577407Medicaid
AR114577407Medicaid