Provider Demographics
NPI:1407842404
Name:MARKET STREET PHARMACY
Entity type:Organization
Organization Name:MARKET STREET PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JEFF
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-670-5098
Mailing Address - Street 1:404 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BEND
Mailing Address - State:AR
Mailing Address - Zip Code:72512-3871
Mailing Address - Country:US
Mailing Address - Phone:870-670-5098
Mailing Address - Fax:870-670-5905
Practice Address - Street 1:404 MARKET ST
Practice Address - Street 2:
Practice Address - City:HORSESHOE BEND
Practice Address - State:AR
Practice Address - Zip Code:72512-3871
Practice Address - Country:US
Practice Address - Phone:870-670-5098
Practice Address - Fax:870-670-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR-16253333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0416253OtherN.A.B.P. NUMBER
ARBM2051821OtherD.E.A. LISCNESE
ARAR-16253OtherARKANSAS PHARMACY LISCENS
ARAR-16253OtherARKANSAS PHARMACY LISCENS