Provider Demographics
NPI:1215020037
Name:CENTRAL DISCOUNT PHARMACY
Entity Type:Organization
Organization Name:CENTRAL DISCOUNT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-452-8686
Mailing Address - Street 1:5400 ELLSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3220
Mailing Address - Country:US
Mailing Address - Phone:479-452-8686
Mailing Address - Fax:479-452-8688
Practice Address - Street 1:5400 ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3220
Practice Address - Country:US
Practice Address - Phone:479-452-8686
Practice Address - Fax:479-452-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100785407Medicaid
AR118798716OtherMEDICAID DME
AR100785407Medicaid