Provider Demographics
NPI:1699170845
Name:WPM COMMUNITY PHARMACIES, LLC
Entity type:Organization
Organization Name:WPM COMMUNITY PHARMACIES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT &CEO
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:PERCY
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-246-5553
Mailing Address - Street 1:PO BOX 524
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-0524
Mailing Address - Country:US
Mailing Address - Phone:870-246-5553
Mailing Address - Fax:870-245-1790
Practice Address - Street 1:3002 PINE ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5325
Practice Address - Country:US
Practice Address - Phone:870-246-3044
Practice Address - Fax:870-245-1738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR120533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0412053OtherNCPDP
AR100758407Medicaid