=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659756104
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CBC SPRINGDALE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2015
-----------------------------------------------------
Last Update Date | 07/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1675 W JEFFERSON ST STE E
-----------------------------------------------------
City | SILOAM SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72761-3001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-599-2240
-----------------------------------------------------
Fax | 479-599-2241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1675 W JEFFERSON ST STE E
-----------------------------------------------------
City | SILOAM SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72761-3001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-599-2240
-----------------------------------------------------
Fax | 479-599-2241
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | ZACH HOLDERFIELD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 870-814-0605
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | AR20046
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------