| NPI | 1225111636 |
|---|---|
| Doing Business As | IKE'S #3 |
| Entity Type | Organization |
| Authorized Contact | GARY M. BOONE Director Of Hme Operations 479-394-6363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy (Licence: TN 1899) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TN 1899) | |
| 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: TN DPO0000000590) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2009-07-07 |