MARVELL CLINIC PHARMACY, INC. NPI 1295752376

Pharmacy in Marvel, AR

NPI 1295752376 Organization Pharmacy CLIA Number 04D2150838 CLIA Certificate of Waiver

About MARVELL CLINIC PHARMACY, INC.

Marvell Clinic Pharmacy, Inc. is a provider established in Marvel, Arkansas specializing in pharmacy. The NPI number of Marvell Clinic Pharmacy, Inc. is 1295752376 and was assigned on July 2006. The practitioner's primary taxonomy code is 333600000X with license number AR20373 (AR). The provider is registered as an organization and their NPI record was last updated 14 years ago. The authorized official of this NPI record is Mr. John William Gray Pharmacist (Owner Pharm)

The CLIA number of Marvell Clinic Pharmacy, Inc. is 04D2150838 registered as a "school/student health service" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Marvell Clinic Pharmacy, Inc. to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1295752376

Provider NameMARVELL CLINIC PHARMACY, INC.
Provider Location Address406 S MILL ST MARVEL, AR 72366
Provider Mailing AddressPO BOX 217 406 S. MILL ST MARVELL, AR 72366
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date07-16-2006
Last Update Date02-11-2008


Primary Taxonomy

Taxonomy Code333600000X
ClassificationPharmacy
TypeSuppliers
License No.AR20373
License StateAR
Taxonomy DescriptionA facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

Business Address

MARVELL CLINIC PHARMACY, INC.
406 S MILL ST
MARVEL, AR
ZIP 72366
Phone: (870) 829-1044
Fax: (870) 829-1067

Get Directions


Mailing Address

MARVELL CLINIC PHARMACY, INC.
PO BOX 217
406 S. MILL ST
MARVELL, AR
ZIP 72366
Phone: (870) 829-1044
Fax: (870) 829-1067



Authorized Official

Authorized Official NameMR. JOHN WILLIAM GRAY PHARMACIST
Authorized Official TitleOWNER PHARM
Authorized Official Phone(870) 829-1044

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1295752376 is:

CLIA Number04D2150838
Facility TypeSCHOOL/STUDENT HEALTH SERVICE
Certificate TypeCertificate of Waiver

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1332B00000XSuppliersDurable Medical Equipment & Medical SuppliesAR20373ARNo

Taxonomy Description: a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
5743090001MEDICARE NSC (07)AR

Other Providers at the same location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1922620483EAST ARKANSAS FAMILY HEALTH CENTER PHARMACY NO. 3, LLC
Organization
Pharmacy (Community/Retail Pharmacy)406 S MILL ST
MARVELL, AR 72366
(870) 829-1168
1962154005MS. PATRICIA TURNER PD
Individual
Pharmacist406 S MILL ST
MARVELL, AR 72366
(870) 829-9116

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.