Healthcare Provider Details

I. General information

NPI: 1427130129
Provider Name (Legal Business Name): HARRIS DRUG STORE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 DEQUEEN AVE
DE QUEEN AR
71832
US

IV. Provider business mailing address

205 DEQUEEN AVE
DE QUEEN AR
71832
US

V. Phone/Fax

Practice location:
  • Phone: 870-584-3555
  • Fax: 870-642-7259
Mailing address:
  • Phone: 870-584-3555
  • Fax: 870-642-7259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR12849
License Number StateAR

VIII. Authorized Official

Name: MR. LARRY DEAN AUTRY
Title or Position: PRESIDENT RPH IN CHARGE
Credential:
Phone: 870-584-3555