Provider Demographics
NPI:1922297779
Name:BEARDEN PHARMACY INC
Entity Type:Organization
Organization Name:BEARDEN PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:OLBOLDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-687-3174
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:BEARDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71720-0627
Mailing Address - Country:US
Mailing Address - Phone:870-687-3174
Mailing Address - Fax:870-687-3600
Practice Address - Street 1:26 N W 1ST STREET
Practice Address - Street 2:
Practice Address - City:BEARDEN
Practice Address - State:AR
Practice Address - Zip Code:71720
Practice Address - Country:US
Practice Address - Phone:870-687-3174
Practice Address - Fax:870-687-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4792810001Medicare NSC