Provider Demographics
NPI:1992369318
Name:ECONO-MART PHARMACY INC
Entity Type:Organization
Organization Name:ECONO-MART PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-793-4179
Mailing Address - Street 1:1595 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7222
Mailing Address - Country:US
Mailing Address - Phone:870-793-4179
Mailing Address - Fax:870-793-7303
Practice Address - Street 1:1595 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7222
Practice Address - Country:US
Practice Address - Phone:870-793-4179
Practice Address - Fax:870-793-7303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ECONO-MART PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy