Healthcare Provider Details

I. General information

NPI: 1871060475
Provider Name (Legal Business Name): DAVIS DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 HIGHWAY 62 412
HIGHLAND AR
72542-9469
US

IV. Provider business mailing address

1243 HIGHWAY 62 412
HIGHLAND AR
72542-9469
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 Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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