MEDICARE: SMITHS COUNTRY CLUB DRUG STORE INC

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	332B00000X	Durable Medical Equipment & Medical Supplies

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

General Provider Information

NPI Number	:	1508847179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITHS COUNTRY CLUB DRUG STORE INC

Provider Business Mailing Address
First Line	:	5114 KAVANAUGH BLVD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-4607
Country	:	US
Telephone Number	:	501-663-4118
Fax Number	:	501-663-4110

Provider Business Practice Location Address
First Line	:	5114 KAVANAUGH BLVD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-4607
Country	:	US
Telephone Number	:	501-663-4118
Fax Number	:	501-663-4110

Authorized Official
Title or Position	:	BILLING AGENT
Name	:	PATRICIA ANN INGELS
Credential	:
Telephone Number	:	501-663-4118

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	09/02/2011

Similar Medicare Providers

1841339645 — SMITHS COUNTRY CLUB DRUG STORE INC
Practice Location Address:

5114 KAVANAUGH BLVD
LITTLE ROCK, AR
72207-4607

Practice Phone: 501-663-4118
Practice Fax: 501-663-4110

1063182558 — MRS. PATRICIA ANN INGELS RPH
Practice Location Address:

5114 KAVANAUGH BLVD
LITTLE ROCK, AR
72207-4607

Practice Phone: 501-663-4118
Practice Fax: 501-663-4118

1801879382 — RANDAL M SUTHERLAND MD
Practice Location Address:

4101 TORRANCE BLVD , LITTLE CO MARY HOSP
TORRANCE, CA
90503-4607

Practice Phone: 310-303-5750
Practice Fax:

1518591973 — BRIANNA MARSICANO
Practice Location Address:

4607 ROCK STREAM DR
CHARLOTTE, NC
28269-7150

Practice Phone: 704-776-6757
Practice Fax:

1750239828 — JESSICA SAYERS
Practice Location Address:

1501 N UNIVERSITY AVE STE 915
LITTLE ROCK, AR
72207-5238

Practice Phone: 501-492-6860
Practice Fax: 501-406-3671

1508993171 — MS. KATHRYN ELIZABETH VARADY LCSW
Practice Location Address:

5905 FOREST PL , SUITE 100
LITTLE ROCK, AR
72207-5244

Practice Phone: 501-666-4949
Practice Fax:

Directions to “SMITHS COUNTRY CLUB DRUG STORE INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.