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General NPI Number Information
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NPI Number | 1295831899
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Entity Type | Organization
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Legal Business Name | C & D DRUG STORE INC
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 121 N COMMERCE AVE
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-3741
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Country | US
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Telephone | 479-968-2456
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Fax | 479-968-7914
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Provider Business Mailing Address
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Address Line | 121 N COMMERCE AVE
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-3741
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Country | US
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Telephone | 479-968-2456
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Fax | 479-968-7914
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROY DEAN WALKER
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Credential | RPH
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Telephone | 479-968-2456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | AR05882
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License Number State | AR
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