Healthcare Provider Details

I. General information

NPI: 1821003435
Provider Name (Legal Business Name): COTTON & EARLS DRUG STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N VAN BUREN ST
WEINER AR
72479-8948
US

IV. Provider business mailing address

212 N VAN BUREN ST
WEINER AR
72479-8948
US

V. Phone/Fax

Practice location:
  • Phone: 870-684-2214
  • Fax: 870-684-7576
Mailing address:
  • Phone: 870-684-2214
  • Fax: 870-684-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR15542
License Number StateAR

VIII. Authorized Official

Name: JESSIE JOHNSON
Title or Position: OWNER
Credential:
Phone: 870-684-2214