Healthcare Provider Details

I. General information

NPI: 1275528069
Provider Name (Legal Business Name): COLLIER DRUG STORES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2005
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 W CENTERTON BLVD
CENTERTON AR
72719-8707
US

IV. Provider business mailing address

PO BOX 1085
FAYETTEVILLE AR
72702
US

V. Phone/Fax

Practice location:
  • Phone: 479-795-8199
  • Fax: 479-795-8196
Mailing address:
  • Phone: 479-442-6262
  • Fax: 479-521-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CARL MELVIN COLLIER
Title or Position: OWNER
Credential:
Phone: 479-442-6262