Provider Demographics
NPI:1235299835
Name:CAMPBELL DRUG CO
Entity Type:Organization
Organization Name:CAMPBELL DRUG CO
Other - Org Name:TRUMANN DRUG CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:870-483-6439
Mailing Address - Street 1:213 HWY 463
Mailing Address - Street 2:
Mailing Address - City:TRUMANN
Mailing Address - State:AR
Mailing Address - Zip Code:72472
Mailing Address - Country:US
Mailing Address - Phone:870-483-6439
Mailing Address - Fax:870-483-7588
Practice Address - Street 1:213 HWY 463
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472
Practice Address - Country:US
Practice Address - Phone:870-483-6439
Practice Address - Fax:870-483-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR02816356001333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0406341OtherNABP#
AR10048407Medicaid
=========OtherFED TAX #
0406341OtherNABP#