MEDICARE: ROSE DRUG OF DOVER, 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	3336C0003X	Community/Retail Pharmacy	AR20230	AR

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	0421052	OTHER	AR	NCPDP NUMBER
3	AR20230	OTHER	AR	RETAIL PHARMACY LICENSE

General Provider Information

NPI Number	:	1881703379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE DRUG OF DOVER, INC

Provider Business Mailing Address
First Line	:	417 UNION ST
Second Line	:
City	:	DARDANELLE
State	:	AR
Zip	:	72834-3429
Country	:	US
Telephone Number	:	479-229-4811
Fax Number	:	479-229-5871

Provider Business Practice Location Address
First Line	:	417 UNION ST
Second Line	:
City	:	DARDANELLE
State	:	AR
Zip	:	72834-3429
Country	:	US
Telephone Number	:	479-228-4811
Fax Number	:	479-229-5871

Authorized Official
Title or Position	:	PHARMACIST/OWNER
Name	:	MR. RICHARD L HARMON
Credential	:	P.D.
Telephone Number	:	479-229-4811

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	04/19/2022

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Directions to “ROSE DRUG OF DOVER, INC ” Practice Location

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