Healthcare Provider Details

I. General information

NPI: 1639480049
Provider Name (Legal Business Name): SMITH DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 JONES RD
PARAGOULD AR
72450-7579
US

IV. Provider business mailing address

1104 JONES RD
PARAGOULD AR
72450-7579
US

V. Phone/Fax

Practice location:
  • Phone: 870-268-6100
  • Fax: 870-268-6125
Mailing address:
  • Phone: 870-268-6100
  • Fax: 870-268-6125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberR09418
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberP00932
License Number StateAR

VIII. Authorized Official

Name: MS. TERRIE J THOMPSON
Title or Position: NURSE MANAGER
Credential: NP
Phone: 870-268-6100