Healthcare Provider Details

I. General information

NPI: 1992703243
Provider Name (Legal Business Name): CALDWELL DISCOUNT DRUG CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 FALLS BLVD S
WYNNE AR
72396-3505
US

IV. Provider business mailing address

PO BOX 1084 804 SOUTH FALLS BLVD
WYNNE AR
72396-1084
US

V. Phone/Fax

Practice location:
  • Phone: 870-238-7085
  • Fax: 870-238-8937
Mailing address:
  • Phone: 870-238-7085
  • Fax: 870-238-8937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberAR-14982
License Number StateAR

VIII. Authorized Official

Name: MAX ALLEN CALDWELL
Title or Position: PHARMACIST/OWNER
Credential: RPH
Phone: 870-238-7085