MEDICARE: AMITY DRUG & SUNDRY

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	AR20525	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0422369	OTHER	AR	NCPDP

General Provider Information

NPI Number	:	1861443558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMITY DRUG & SUNDRY

Provider Business Mailing Address
First Line	:	PO BOX 156
Second Line	:
City	:	AMITY
State	:	AR
Zip	:	71921-0156
Country	:	US
Telephone Number	:	870-342-5080
Fax Number	:	870-342-5002

Provider Business Practice Location Address
First Line	:	109 W THOMPSON ST
Second Line	:
City	:	AMITY
State	:	AR
Zip	:	71921-9135
Country	:	US
Telephone Number	:	870-342-5080
Fax Number	:	870-342-5002

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MRS. DEANNA LUEKENGA
Credential	:
Telephone Number	:	870-342-5080

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	08/22/2020

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Directions to “AMITY DRUG & SUNDRY ” Practice Location

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