Provider Demographics
NPI:1982958484
Name:POTTSVILLE PHARMACY INC
Entity Type:Organization
Organization Name:POTTSVILLE PHARMACY INC
Other - Org Name:POTTSVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:479-498-4130
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72858-0299
Mailing Address - Country:US
Mailing Address - Phone:479-498-4130
Mailing Address - Fax:479-498-4133
Practice Address - Street 1:5395 W ASH ST
Practice Address - Street 2:SUITE 9
Practice Address - City:POTTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72858-9170
Practice Address - Country:US
Practice Address - Phone:479-498-4130
Practice Address - Fax:479-498-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy