Provider Demographics
NPI:1306104989
Name:MENA REGIONAL HEALTH SYSTEM PHARMACY
Entity type:Organization
Organization Name:MENA REGIONAL HEALTH SYSTEM PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPRIEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-394-6100
Mailing Address - Street 1:311 MORROW ST N
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-2516
Mailing Address - Country:US
Mailing Address - Phone:479-394-6100
Mailing Address - Fax:479-394-4577
Practice Address - Street 1:311 MORROW ST N
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-2516
Practice Address - Country:US
Practice Address - Phone:479-394-6100
Practice Address - Fax:479-394-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy