Healthcare Provider Details

I. General information

NPI: 1023099660
Provider Name (Legal Business Name): COLLEGE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E STADIUM
MAGNOLIA AR
71753-2032
US

IV. Provider business mailing address

211 E STADIUM
MAGNOLIA AR
71753-2032
US

V. Phone/Fax

Practice location:
  • Phone: 870-234-7292
  • Fax: 870-234-4443
Mailing address:
  • Phone: 870-234-7292
  • Fax: 870-234-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20042
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY PRINCE
Title or Position: OWNER PHCST
Credential:
Phone: 870-234-7292