Provider Demographics
NPI:1245035260
Name:WEST SIDE PHARMACY- MILITARY ROAD LLC
Entity type:Organization
Organization Name:WEST SIDE PHARMACY- MILITARY ROAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MADDISON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-778-3151
Mailing Address - Street 1:620 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-4258
Mailing Address - Country:US
Mailing Address - Phone:501-778-3151
Mailing Address - Fax:501-778-7329
Practice Address - Street 1:1525 MILITARY ROAD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015
Practice Address - Country:US
Practice Address - Phone:501-778-3151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy