Provider Demographics
NPI:1780051219
Name:MEDI-QUIK DISCOUNT PHARMACY #3,INC
Entity type:Organization
Organization Name:MEDI-QUIK DISCOUNT PHARMACY #3,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WOOLSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:479-963-1555
Mailing Address - Street 1:406 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:AR
Mailing Address - Zip Code:72855-3920
Mailing Address - Country:US
Mailing Address - Phone:479-963-1555
Mailing Address - Fax:479-963-1560
Practice Address - Street 1:406 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:AR
Practice Address - Zip Code:72855-3920
Practice Address - Country:US
Practice Address - Phone:479-963-1555
Practice Address - Fax:479-963-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD083653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163928407Medicaid
AR163928407Medicaid