Basic Information
| Provider Information | |||||||||
| NPI: | 1548527757 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEDRELIEF PHARMACY LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MEDRELIEF PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2485 | ||||||||
| Address2: | |||||||||
| City: | WEST MEMPHIS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723032485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707391700 | ||||||||
| FaxNumber: | 8707391702 | ||||||||
| Practice Location | |||||||||
| Address1: | 2895 STATE HIGHWAY 77 S STE 3 | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723642371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707391700 | ||||||||
| FaxNumber: | 8707391702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2012 | ||||||||
| LastUpdateDate: | 06/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | BATTAGLIA | ||||||||
| AuthorizedOfficialFirstName: | PETE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8707391700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | AR20672 | AR | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 0423917 | 01 | NCPDP PROVIDER IDENTIFICATION NUMBER | OTHER |