Healthcare Provider Details

I. General information

NPI: 1306280771
Provider Name (Legal Business Name): CALDWELL DISCOUNT DRUG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 04/29/2013
Certification Date:
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
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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR14982
License Number StateAR

VIII. Authorized Official

Name: MR. MAX A CALDWELL
Title or Position: PRESIDENT / OWNER
Credential: P.D.
Phone: 870-238-7085