Provider Demographics
NPI:1689749426
Name:RONALD MYERS
Entity Type:Organization
Organization Name:RONALD MYERS
Other - Org Name:MYERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-625-3214
Mailing Address - Street 1:P O BOX 69
Mailing Address - Street 2:226 MAIN ST
Mailing Address - City:MAMMOTH SPRING
Mailing Address - State:AR
Mailing Address - Zip Code:72554-0069
Mailing Address - Country:US
Mailing Address - Phone:870-625-3214
Mailing Address - Fax:870-625-3215
Practice Address - Street 1:226 MAIN
Practice Address - Street 2:
Practice Address - City:MAMMOTH SPRING
Practice Address - State:AR
Practice Address - Zip Code:72554
Practice Address - Country:US
Practice Address - Phone:870-625-3214
Practice Address - Fax:870-625-3215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAM1358298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0412077OtherNABP
4098740001Medicare ID - Type Unspecified