Healthcare Provider Details

I. General information

NPI: 1740371475
Provider Name (Legal Business Name): MONTICELLO DRUG COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EAST GAINES
MONTICELLO AR
71655
US

IV. Provider business mailing address

PO BOX 552
LAKE VILLAGE AR
71653-0552
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-5301
  • Fax: 870-460-0257
Mailing address:
  • Phone: 870-367-5301
  • Fax: 870-460-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberAR11936
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR11936
License Number StateAR

VIII. Authorized Official

Name: KHALIL LYNN CROUSE
Title or Position: OWNER/PHARMD
Credential:
Phone: 870-265-2220