MEDICARE: ROSE DRUG OF DOVER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	010491	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508970393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE DRUG OF DOVER INC

Provider Business Mailing Address
First Line	:	8880 MARKET ST
Second Line	:
City	:	DOVER
State	:	AR
Zip	:	72837-9111
Country	:	US
Telephone Number	:	479-331-2133
Fax Number	:	479-331-4003

Provider Business Practice Location Address
First Line	:	8880 MARKET ST
Second Line	:
City	:	DOVER
State	:	AR
Zip	:	72837-9111
Country	:	US
Telephone Number	:	479-331-2133
Fax Number	:	479-331-4003

Authorized Official
Title or Position	:	PHARMACIST
Name	:	DR. RICHARD L. HARMON
Credential	:	PD
Telephone Number	:	479-331-2133

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	05/10/2022

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Directions to “ROSE DRUG OF DOVER INC ” Practice Location

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