Provider Demographics
NPI:1306985353
Name:EMMANUEL INC
Entity type:Organization
Organization Name:EMMANUEL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:HARKNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-327-8088
Mailing Address - Street 1:2125 COLLEGE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2125 COLLEGE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6210
Practice Address - Country:US
Practice Address - Phone:501-327-8088
Practice Address - Fax:501-730-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR201493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0411671OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0411671OtherOTHER ID NUMBER
0411671OtherOTHER ID NUMBER