Provider Demographics
NPI:1295831899
Name:C & D DRUG STORE INC
Entity Type:Organization
Organization Name:C & D DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:479-968-2456
Mailing Address - Street 1:121 N COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3741
Mailing Address - Country:US
Mailing Address - Phone:479-968-2456
Mailing Address - Fax:479-968-7914
Practice Address - Street 1:121 N COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3741
Practice Address - Country:US
Practice Address - Phone:479-968-2456
Practice Address - Fax:479-968-7914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR058823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124449716Medicaid
AR100080407Medicaid
AR0622270001Medicare NSC