Provider Demographics
NPI:1952814857
Name:HEALTH-WISE PHARMACY PLLC
Entity Type:Organization
Organization Name:HEALTH-WISE PHARMACY PLLC
Other - Org Name:HEALTH-WISE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PLLC
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-637-3300
Mailing Address - Street 1:47 S HWY 71 BYPASS
Mailing Address - Street 2:
Mailing Address - City:WALDRON
Mailing Address - State:AR
Mailing Address - Zip Code:72958
Mailing Address - Country:US
Mailing Address - Phone:479-637-3300
Mailing Address - Fax:479-637-3304
Practice Address - Street 1:47 S HWY 71 BYPASS
Practice Address - Street 2:
Practice Address - City:WALDRON
Practice Address - State:AR
Practice Address - Zip Code:72958
Practice Address - Country:US
Practice Address - Phone:479-637-3300
Practice Address - Fax:479-637-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR208653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2172847OtherPK