Healthcare Provider Details

I. General information

NPI: 1407844418
Provider Name (Legal Business Name): YELLVILLE DRUG STORE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 HIGHWAY 62 W
YELLVILLE AR
72687-9924
US

IV. Provider business mailing address

PO BOX 730
YELLVILLE AR
72687-0730
US

V. Phone/Fax

Practice location:
  • Phone: 870-449-4099
  • Fax:
Mailing address:
  • Phone: 870-449-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberAR06644
License Number StateAR

VIII. Authorized Official

Name: DR. PAUL SCOTT
Title or Position: PRESIDENT
Credential: P.D.
Phone: 870-449-4099