Healthcare Provider Details

I. General information

NPI: 1295964047
Provider Name (Legal Business Name): COLEMAN PHARMACY OF CRAWFORD COUNTY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 08/29/2022
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 FAYETTEVILLE AVE
ALMA AR
72921-3654
US

IV. Provider business mailing address

PO BOX 2550
ALMA AR
72921-2550
US

V. Phone/Fax

Practice location:
  • Phone: 479-632-2248
  • Fax: 479-632-2386
Mailing address:
  • Phone: 479-632-2248
  • Fax: 479-632-2386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number01466
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVE BRYANT JR.
Title or Position: OWNER
Credential: PHARM D
Phone: 870-793-3999