Healthcare Provider Details

I. General information

NPI: 1396882122
Provider Name (Legal Business Name): TOMMYS REXALL DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 COURT SQ
DE WITT AR
72042-2057
US

IV. Provider business mailing address

220 COURT SQ
DE WITT AR
72042-2057
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-4221
  • Fax: 870-946-1181
Mailing address:
  • Phone: 870-946-4221
  • Fax: 870-946-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TOMMY BLACK
Title or Position: OWNER
Credential:
Phone: 870-946-4221