Healthcare Provider Details

I. General information

NPI: 1942296603
Provider Name (Legal Business Name): HOLLY STREET DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 HOLLY ST
MC GEHEE AR
71654-2111
US

IV. Provider business mailing address

PO BOX 869
MC GEHEE AR
71654-0869
US

V. Phone/Fax

Practice location:
  • Phone: 870-222-3080
  • Fax: 870-222-6561
Mailing address:
  • Phone: 870-222-3080
  • Fax: 870-222-6561

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 NumberAR17673
License Number StateAR

VIII. Authorized Official

Name: RONALD NORRIS
Title or Position: OWNER
Credential:
Phone: 870-222-3080