Healthcare Provider Details

I. General information

NPI: 1073921177
Provider Name (Legal Business Name): COLLIER DRUG STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 N MAESTRI RD STE 3
SPRINGDALE AR
72762-9818
US

IV. Provider business mailing address

PO BOX 1085
FAYETTEVILLE AR
72702-1085
US

V. Phone/Fax

Practice location:
  • Phone: 479-361-5727
  • Fax: 479-361-5623
Mailing address:
  • Phone: 479-935-4303
  • Fax: 479-521-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20756
License Number StateAR

VIII. Authorized Official

Name: CARL MELVIN COLLIER JR.
Title or Position: OWNER
Credential:
Phone: 479-442-6262