Provider Demographics
NPI:1578562195
Name:GRIFFINS PHARMACY INC
Entity Type:Organization
Organization Name:GRIFFINS PHARMACY INC
Other - Org Name:GRIFFINS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WINFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-533-4351
Mailing Address - Street 1:239 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STAMPS
Mailing Address - State:AR
Mailing Address - Zip Code:71860-2827
Mailing Address - Country:US
Mailing Address - Phone:870-533-4351
Mailing Address - Fax:870-533-4351
Practice Address - Street 1:239 MAIN ST
Practice Address - Street 2:
Practice Address - City:STAMPS
Practice Address - State:AR
Practice Address - Zip Code:71860-2827
Practice Address - Country:US
Practice Address - Phone:870-533-4351
Practice Address - Fax:870-533-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR200263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100790407Medicaid
1994235OtherPK