Provider Demographics
NPI:1891576286
Name:WYNNE APOTHECARY INC
Entity Type:Organization
Organization Name:WYNNE APOTHECARY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:E
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-238-8511
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-0361
Mailing Address - Country:US
Mailing Address - Phone:870-238-8511
Mailing Address - Fax:870-238-2135
Practice Address - Street 1:500 FALLS BLVD N
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-2612
Practice Address - Country:US
Practice Address - Phone:870-238-8511
Practice Address - Fax:870-238-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy