Healthcare Provider Details

I. General information

NPI: 1871694513
Provider Name (Legal Business Name): DAVIS DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 HIGHWAY 62 412
HIGHLAND AR
72542-9469
US

IV. Provider business mailing address

PO BOX 428
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 TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberAR20337
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberAR20337
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20337
License Number StateAR

VIII. Authorized Official

Name: ANDREA D TAYLOR
Title or Position: OWNER
Credential: PHARM D
Phone: 870-856-3080