Provider Demographics
NPI:1427823327
Name:CROWN YOURS RX
Entity type:Organization
Organization Name:CROWN YOURS RX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR/ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-205-6404
Mailing Address - Street 1:1023 MAIN ST STE 211
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5425
Mailing Address - Country:US
Mailing Address - Phone:501-238-1261
Mailing Address - Fax:501-307-3696
Practice Address - Street 1:1023 MAIN ST STE 211
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5425
Practice Address - Country:US
Practice Address - Phone:501-238-1261
Practice Address - Fax:501-307-3696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier