Healthcare Provider Details

I. General information

NPI: 1215020037
Provider Name (Legal Business Name): CENTRAL DISCOUNT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 ELLSWORTH RD
FORT SMITH AR
72903-3220
US

IV. Provider business mailing address

5400 ELLSWORTH RD
FORT SMITH AR
72903-3220
US

V. Phone/Fax

Practice location:
  • Phone: 479-452-8686
  • Fax: 479-452-8688
Mailing address:
  • Phone: 479-452-8686
  • Fax: 479-452-8688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RONALD SMITH
Title or Position: OWNER
Credential:
Phone: 479-452-8686