Econo-Med of Walnut Ridge Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

AR20135 Issued in AR

Legal business name

ECONO-MED OF WALNUT RIDGE INC

Practice address

1045 W Main St
Ste B
Walnut Ridge, AR 72476-1004

Phone

(870) 886-5200

Fax

(870) 886-7553

NPI assigned

May 8, 2017

Last updated

May 3, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Greta IshmaelNPI 1477957157

Title

Owner/Ao

Phone

(870) 856-4696

Specialties & licenses 2

Addresses

Other identifiers 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Greta Ishmael, PHARMD

  • Pharmacist
  • Cherokee Village, AR
  • NPI 1477957157
  NPD Authorized official
• Lauren Felts Crook, PHARMD

  • Pharmacist
  • Walnut Ridge, AR
  • NPI 1871113126
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1494201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525305600000",
    "number": "1063948289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHOCTAW CTR",
            "city": "CHEROKEE VILLAGE",
            "state": "AR",
            "postal_code": "725292701",
            "telephone_number": "870-856-4696",
            "fax_number": "870-856-4658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 W MAIN ST",
            "address_2": "STE B",
            "city": "WALNUT RIDGE",
            "state": "AR",
            "postal_code": "724761004",
            "telephone_number": "870-886-5200",
            "fax_number": "870-886-7553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ECONO-MED OF WALNUT RIDGE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-08",
        "last_updated": "2018-05-03",
        "status": "A",
        "authorized_official_last_name": "ISHMAEL",
        "authorized_official_first_name": "GRETA",
        "authorized_official_title_or_position": "OWNER/AO",
        "authorized_official_telephone_number": "870-856-4696"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR20135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "219073407",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2168755",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diversicare Leasing Corp. (Walnut Ridge Nursing and Rehabilitation Center)
• Karla Ann Dotson, LCSW
• Brittany Doyle, MCD,CCC-SLP
• Justin Drum
• Caleb Matthew Dunbar
• Varghese Edattukaren, MD
• Benjamin Engelken, PHARMD
• Terri Evans
• Families, Inc. of Arkansas (Families, Inc.)
• Family Clinic Pharmacy, LLC

• Community/Retail Pharmacy in Walnut Ridge, AR
• Providers in Walnut Ridge, AR by specialty
• Community/Retail Pharmacy in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.