Provider Demographics
NPI:1598160558
Name:ECONO-MED PHARMACY. INC.
Entity Type:Organization
Organization Name:ECONO-MED PHARMACY. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-856-4696
Mailing Address - Street 1:1 CHOCTAW CTR
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72529-2701
Mailing Address - Country:US
Mailing Address - Phone:870-856-4696
Mailing Address - Fax:
Practice Address - Street 1:1 CHOCTAW CTR
Practice Address - Street 2:
Practice Address - City:CHEROKEE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:72529-2701
Practice Address - Country:US
Practice Address - Phone:870-856-4696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR202023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145641716Medicaid
AR4233360001Medicare NSC