Provider Demographics
NPI:1639260474
Name:POLK PHARMACY INC
Entity Type:Organization
Organization Name:POLK PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-295-3441
Mailing Address - Street 1:4 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:AR
Mailing Address - Zip Code:72360-2320
Mailing Address - Country:US
Mailing Address - Phone:870-295-3441
Mailing Address - Fax:870-298-2635
Practice Address - Street 1:4 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:AR
Practice Address - Zip Code:72360-2320
Practice Address - Country:US
Practice Address - Phone:870-295-3441
Practice Address - Fax:870-298-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy