Provider Demographics
NPI:1912087446
Name:NORTH PARK PHARMACY INC
Entity Type:Organization
Organization Name:NORTH PARK PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:870-642-3784
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:DEQUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832
Mailing Address - Country:US
Mailing Address - Phone:870-642-3784
Mailing Address - Fax:870-642-5827
Practice Address - Street 1:821 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:DEQUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832
Practice Address - Country:US
Practice Address - Phone:870-642-3784
Practice Address - Fax:870-642-5827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR13776333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0413776OtherNCPDP