Provider Demographics
NPI:1326674870
Name:CARAWAY DRUG L.L.C
Entity Type:Organization
Organization Name:CARAWAY DRUG L.L.C
Other - Org Name:CARAWAY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:870-351-2697
Mailing Address - Street 1:4308 CLUBHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-8081
Mailing Address - Country:US
Mailing Address - Phone:870-351-2697
Mailing Address - Fax:
Practice Address - Street 1:106 W. STATE STREET
Practice Address - Street 2:
Practice Address - City:CARAWAY
Practice Address - State:AR
Practice Address - Zip Code:72419
Practice Address - Country:US
Practice Address - Phone:870-838-5750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy