Healthcare Provider Details

I. General information

NPI: 1609084565
Provider Name (Legal Business Name): SMITH DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 EAST THIRD STREET
GENTRY AR
72737-0629
US

IV. Provider business mailing address

PO BOX 629
GENTRY AR
72734-0629
US

V. Phone/Fax

Practice location:
  • Phone: 479-736-2241
  • Fax: 473-736-8081
Mailing address:
  • Phone: 479-736-2241
  • Fax: 479-736-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR11140
License Number StateAR

VIII. Authorized Official

Name: DR. STEPHEN D SMITH
Title or Position: PHARMACIST
Credential: PD
Phone: 479-736-2241