Provider Demographics
NPI:1881757706
Name:STONEWOOD VILLAGE PHARMACY INC
Entity type:Organization
Organization Name:STONEWOOD VILLAGE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AUBRY
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:479-452-8290
Mailing Address - Street 1:7320 ROGERS AVE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4164
Mailing Address - Country:US
Mailing Address - Phone:479-452-8290
Mailing Address - Fax:479-452-4304
Practice Address - Street 1:7320 ROGERS AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4164
Practice Address - Country:US
Practice Address - Phone:479-452-8290
Practice Address - Fax:479-452-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR13334333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0413334OtherNABP