Organization Name: | WYNNE APOTHECARY INC |
NPI Number: | 1508859737 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICHARD BOECKMANN (OWNER) |
Mailing Address: | 411 Falls Blvd S Wynne |
State: | AR US |
Postal Code: | 723963501 |
Phone Number: | 8702388511 |
Fax Number: | 8702382135 |
NPI Enumeration Date: | 08/23/2005 |
NPI Last Update Date: | 08/23/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0004X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Pharmacy |
Taxonomy Specialization: | Compounding Pharmacy |
Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |