Healthcare Provider Details

I. General information

NPI: 1942337811
Provider Name (Legal Business Name): BEARD DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 S LINCOLN AVE
STAR CITY AR
71667-5802
US

IV. Provider business mailing address

614 S LINCOLN AVE
STAR CITY AR
71667-5802
US

V. Phone/Fax

Practice location:
  • Phone: 870-628-4277
  • Fax: 870-628-4278
Mailing address:
  • Phone: 870-628-4277
  • Fax: 870-628-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0406202
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0406202
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0406202
License Number StateAR

VIII. Authorized Official

Name: ROLAND EDWARD BEARD
Title or Position: PHARMACIST OWNER
Credential:
Phone: 870-628-4277