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NPI Code Detail

MEDICARE: CALDWELL DISCOUNT DRUG

MEDICARE: CALDWELL DISCOUNT DRUG
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
1174N00000XLactation Consultant (Non-RN)42975MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
142975OTHERARACADEMY OF LACATATION POLICY AND PRACTICE

General Provider Information

NPI Number : 1295078178
Entity Type Code : Organization
Provider Name (Legal Business Name) : CALDWELL DISCOUNT DRUG
Provider Business Mailing Address
First Line : 804 FALLS BLVD S
Second Line :
City : WYNNE
State : AR
Zip : 72396-3505
Country : US
Telephone Number : 870-238-7085
Fax Number : 870-238-8937
Provider Business Practice Location Address
First Line : 804 FALLS BLVD S
Second Line :
City : WYNNE
State : AR
Zip : 72396-3505
Country : US
Telephone Number : 870-238-7085
Fax Number : 870-238-8937
Authorized Official
Title or Position : OWNER/PHARMACIST
Name : MAX CALDWELL
Credential : PHARMACIST
Telephone Number : 870-238-7085
Provider Enumeration Date : 03/29/2013
Last Update Date : 03/29/2013

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Practice Location Address:
804 FALLS BLVD S
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804 FALLS BLVD S
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Practice Location Address:
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Practice Fax: 870-238-8937

Directions to “CALDWELL DISCOUNT DRUG ” Practice Location

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