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General NPI Number Information
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NPI Number | 1700947272
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Entity Type | Organization
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Legal Business Name | CLINIC DRUG STORE, INC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1700 HARRISON ST STE D
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City | BATESVILLE
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State | AR
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Zip | 72501
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Country | US
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Telephone | 870-793-5170
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Fax | 870-793-4996
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Provider Business Mailing Address
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Address Line | 1700 HARRISON ST STE D
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City | BATESVILLE
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State | AR
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Zip | 72501
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Country | US
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Telephone | 870-793-5170
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Fax | 870-793-4996
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | PHILIP H BAKER
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Credential | PD
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Telephone | 870-793-5170
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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 | 0416467
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License Number State | AR
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