Healthcare Provider Details

I. General information

NPI: 1336208602
Provider Name (Legal Business Name): BRUCE DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 BROADWAY ST
SMACKOVER AR
71762-1822
US

IV. Provider business mailing address

711 BROADWAY ST
SMACKOVER AR
71762-1822
US

V. Phone/Fax

Practice location:
  • Phone: 870-725-2401
  • Fax: 870-725-2853
Mailing address:
  • Phone: 870-725-2401
  • Fax: 870-725-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0406101
License Number StateAR

VIII. Authorized Official

Name: MR. ED. F HENLEY
Title or Position: OWNER
Credential: PH.D
Phone: 870-863-9867