Provider Demographics
NPI:1205823002
Name:CHAMBERS DRUG, INC.
Entity Type:Organization
Organization Name:CHAMBERS DRUG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:LUKAS
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:501-982-2117
Mailing Address - Street 1:630 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4432
Mailing Address - Country:US
Mailing Address - Phone:501-982-2117
Mailing Address - Fax:501-985-0739
Practice Address - Street 1:630 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4432
Practice Address - Country:US
Practice Address - Phone:501-982-2117
Practice Address - Fax:501-985-0739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR65685333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100882407Medicaid
AR498296001Medicare ID - Type Unspecified