Provider Demographics
NPI:1538997150
Name:HART, STORY
Entity type:Individual
Prefix:
First Name:STORY
Middle Name:
Last Name:HART
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S DIXIELAND ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-8655
Mailing Address - Country:US
Mailing Address - Phone:479-334-5239
Mailing Address - Fax:833-998-4801
Practice Address - Street 1:112 S DIXIELAND ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-8655
Practice Address - Country:US
Practice Address - Phone:479-334-5239
Practice Address - Fax:833-998-4801
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD17069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist