Provider Demographics
NPI:1922620483
Name:EAST ARKANSAS FAMILY HEALTH CENTER PHARMACY NO. 3, LLC
Entity Type:Organization
Organization Name:EAST ARKANSAS FAMILY HEALTH CENTER PHARMACY NO. 3, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-735-3842
Mailing Address - Street 1:900 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-2001
Mailing Address - Country:US
Mailing Address - Phone:870-733-6341
Mailing Address - Fax:870-394-9541
Practice Address - Street 1:406 S MILL ST
Practice Address - Street 2:
Practice Address - City:MARVELL
Practice Address - State:AR
Practice Address - Zip Code:72366-7236
Practice Address - Country:US
Practice Address - Phone:870-829-1168
Practice Address - Fax:870-829-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy