Healthcare Provider Details

I. General information

NPI: 1942399043
Provider Name (Legal Business Name): DAVIS DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 HWY 62 167
HARDY AR
72542
US

IV. Provider business mailing address

PO BOX 177
ASH FLAT AR
72513-0428
US

V. Phone/Fax

Practice location:
  • Phone: 870-856-3080
  • Fax: 870-856-4165
Mailing address:
  • Phone: 870-856-3080
  • Fax: 870-856-4165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ANDREA DAVIS
Title or Position: OWNER
Credential:
Phone: 870-856-3080