Provider Demographics
NPI:1043095516
Name:LEWIS COOK DRUG STORE INC
Entity Type:Organization
Organization Name:LEWIS COOK DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEDSKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:870-552-7837
Mailing Address - Street 1:PO BOX L
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:AR
Mailing Address - Zip Code:72024-1512
Mailing Address - Country:US
Mailing Address - Phone:870-552-7837
Mailing Address - Fax:833-678-0091
Practice Address - Street 1:121 NORTH COURT STREET
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:AR
Practice Address - Zip Code:72024
Practice Address - Country:US
Practice Address - Phone:870-552-7837
Practice Address - Fax:833-678-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100365407Medicaid