Provider Demographics
NPI:1447320528
Name:WPM COMMUNITY PHARMACIES LLC
Entity type:Organization
Organization Name:WPM COMMUNITY PHARMACIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-246-5553
Mailing Address - Street 1:PO BOX 524
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-0524
Mailing Address - Country:US
Mailing Address - Phone:870-246-5553
Mailing Address - Fax:870-246-6616
Practice Address - Street 1:216 S 13TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-4204
Practice Address - Country:US
Practice Address - Phone:479-621-0400
Practice Address - Fax:479-621-7079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
ARAR195023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130417407Medicaid
1988123OtherPK
0288620001Medicare NSC