Provider Demographics
NPI:1871128306
Name:SOUTHEAST ARKANSAS PHARMACIES LLC
Entity type:Organization
Organization Name:SOUTHEAST ARKANSAS PHARMACIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-367-4227
Mailing Address - Street 1:539 HIGHWAY 425 S
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-4674
Mailing Address - Country:US
Mailing Address - Phone:870-367-4227
Mailing Address - Fax:870-367-4211
Practice Address - Street 1:539 HIGHWAY 425 S
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4674
Practice Address - Country:US
Practice Address - Phone:870-367-4227
Practice Address - Fax:870-367-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy