Provider Demographics
NPI:1588817787
Name:MEDI-QUIK PHARMACY INC
Entity type:Organization
Organization Name:MEDI-QUIK PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOOLSEY
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:479-667-4145
Mailing Address - Street 1:810 W COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949-3010
Mailing Address - Country:US
Mailing Address - Phone:479-667-4145
Mailing Address - Fax:479-667-4879
Practice Address - Street 1:810 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949-3010
Practice Address - Country:US
Practice Address - Phone:479-667-4145
Practice Address - Fax:479-667-4879
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDI-QUIK PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-31
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102237716Medicaid
AR102237716Medicaid