Healthcare Provider Details

I. General information

NPI: 1770055923
Provider Name (Legal Business Name): GOSNELL DRUGS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 BEVILL AVE
GOSNELL AR
72315
US

IV. Provider business mailing address

134 BEVILL AVE
GOSNELL AR
72315
US

V. Phone/Fax

Practice location:
  • Phone: 573-559-5525
  • Fax:
Mailing address:
  • Phone: 870-751-9242
  • Fax: 870-751-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TYSON WALLACE
Title or Position: OWNER/PHARMACIST
Credential: PHARM. D.
Phone: 870-751-9242