Provider Demographics
NPI:1740320431
Name:MEDI-MART PHARMACY
Entity type:Organization
Organization Name:MEDI-MART PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST & MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:CURRY
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-734-3161
Mailing Address - Street 1:111 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRINKLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72021-2819
Mailing Address - Country:US
Mailing Address - Phone:870-734-3161
Mailing Address - Fax:870-734-1322
Practice Address - Street 1:111 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRINKLEY
Practice Address - State:AR
Practice Address - Zip Code:72021-2819
Practice Address - Country:US
Practice Address - Phone:870-734-3161
Practice Address - Fax:870-734-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR162413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAR16241OtherPHARMACY LICENSE PERMIT
ARAR16241OtherPHARMACY LICENSE PERMIT