Healthcare Provider Details

I. General information

NPI: 1588091201
Provider Name (Legal Business Name): COLLIER DRUG STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2491 N. CENTER STREET
ELKINS AR
72727
US

IV. Provider business mailing address

PO BOX 1085
FAYETTEVILLE AR
72702-1085
US

V. Phone/Fax

Practice location:
  • Phone: 479-442-6060
  • Fax: 479-442-0606
Mailing address:
  • Phone: 479-935-4303
  • Fax: 479-521-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20729
License Number StateAR

VIII. Authorized Official

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