Healthcare Provider Details

I. General information

NPI: 1124048699
Provider Name (Legal Business Name): ECONOMY DRUG OF DEWITT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 S MADISON ST
DEWITT AR
72042-3003
US

IV. Provider business mailing address

PO BOX 588
DE WITT AR
72042-0588
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-1706
  • Fax: 870-946-3024
Mailing address:
  • Phone: 870-946-1048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberAR15972
License Number StateAR

VIII. Authorized Official

Name: ALTON CHAMBLESS
Title or Position: OWNER/CHIEF PHARMACIST
Credential:
Phone: 870-946-1706