Mary Carole M Polk, RPH
Individual provider Active NPI Pharmacist · Clarendon, AR
NPI 1770685083 · NPPES record last updated Dec 27, 2024
Key facts
- NPI
- 1770685083
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 7925 (AR)
- Practice address
- 333 Madison Street
Clarendon, AR 72029 - Phone
- (870) 747-3304
- NPI assigned
- Sep 5, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7925 | AR | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 7925 | AR | Yes |
Addresses
Primary practice location
333 Madison Street
Clarendon, AR 72029
Mailing address
55 Normandy LN
Little Rock, AR 72207-4201
Phone (501) 690-7519
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20-0270245 | Other | AR | FEDERAL TAX ID |
| 281107-48-001 | Other | AR | SALES AND USE TAX NUMBER |
| 1291951 | Medicaid | LA | |
| 124343407 | Medicaid | AR |
Other providers in Clarendon, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.