MEDICARE: CENTRAL DISCOUNT PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215020037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL DISCOUNT PHARMACY

Provider Business Mailing Address
First Line	:	5400 ELLSWORTH RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3220
Country	:	US
Telephone Number	:	479-452-8686
Fax Number	:	479-452-8688

Provider Business Practice Location Address
First Line	:	5400 ELLSWORTH RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3220
Country	:	US
Telephone Number	:	479-452-8686
Fax Number	:	479-452-8688

Authorized Official
Title or Position	:	OWNER
Name	:	RONALD SMITH
Credential	:
Telephone Number	:	479-452-8686

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	06/08/2016

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Directions to “CENTRAL DISCOUNT PHARMACY ” Practice Location

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