Healthcare Provider Details

I. General information

NPI: 1033252267
Provider Name (Legal Business Name): FOOTES SUPER DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 EAST ADAMS STREET
HAMBURG AR
71646
US

IV. Provider business mailing address

109 EAST ADAMS STREET
HAMBURG AR
71646
US

V. Phone/Fax

Practice location:
  • Phone: 870-853-5275
  • Fax: 870-853-8000
Mailing address:
  • Phone: 870-853-5275
  • Fax: 870-853-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR10554
License Number StateAR

VIII. Authorized Official

Name: MR. JEFF SAWYER FOOTE SR.
Title or Position: PRESIDENT
Credential:
Phone: 870-853-5275