Provider Demographics
NPI:1366542318
Name:GUFFEYS PHARMACY INC
Entity type:Organization
Organization Name:GUFFEYS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GUFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-895-2143
Mailing Address - Street 1:PO BOX 979
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AR
Mailing Address - Zip Code:72576-0979
Mailing Address - Country:US
Mailing Address - Phone:870-895-2143
Mailing Address - Fax:870-895-3788
Practice Address - Street 1:172 HWY 62 E
Practice Address - Street 2:SUITE 2
Practice Address - City:SALEM
Practice Address - State:AR
Practice Address - Zip Code:72576-0155
Practice Address - Country:US
Practice Address - Phone:870-895-2143
Practice Address - Fax:870-895-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR059693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0405969OtherNCPDP PROVIDER IDENTIFICATION NUMBER