MEDICARE: CITY DRUG AND SODA FOUNTAIN

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	333600000X	Pharmacy	AR18598	AR
2	3336C0003X	Community/Retail Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0418598	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1861585002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY DRUG AND SODA FOUNTAIN

Provider Business Mailing Address
First Line	:	PO BOX 865
Second Line	:
City	:	MOUNT IDA
State	:	AR
Zip	:	71957-0865
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 W S WEST STREET
Second Line	:
City	:	MOUNT IDA
State	:	AR
Zip	:	71957
Country	:	US
Telephone Number	:	870-867-3310
Fax Number	:	870-867-4848

Authorized Official
Title or Position	:	VP
Name	:	MICHAEL HOBSON
Credential	:
Telephone Number	:	870-867-3310

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/11/2025

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Directions to “CITY DRUG AND SODA FOUNTAIN ” Practice Location

Language	Start Address	Practice Location

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