Provider Demographics
NPI:1275755696
Name:SALEM DRUG COMPANY, INC
Entity Type:Organization
Organization Name:SALEM DRUG COMPANY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:CAROLANN
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-895-7455
Mailing Address - Street 1:PO BOX 940
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AR
Mailing Address - Zip Code:72576-0940
Mailing Address - Country:US
Mailing Address - Phone:870-895-7455
Mailing Address - Fax:870-895-3784
Practice Address - Street 1:502 HWY 62 WEST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AR
Practice Address - Zip Code:72576
Practice Address - Country:US
Practice Address - Phone:870-895-7455
Practice Address - Fax:870-895-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR201293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1264750001Medicare NSC