Provider Demographics
NPI:1346247210
Name:LEWIS COOK DRUG STORE INC
Entity Type:Organization
Organization Name:LEWIS COOK DRUG STORE INC
Other - Org Name:MEDSKERS FAMILY PHARMACY AND GIFT SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDSKER
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-552-7837
Mailing Address - Street 1:PO BOX L
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:AR
Mailing Address - Zip Code:72024-1512
Mailing Address - Country:US
Mailing Address - Phone:870-552-7837
Mailing Address - Fax:
Practice Address - Street 1:121 NORTH COURT STREET
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:AR
Practice Address - Zip Code:72024
Practice Address - Country:US
Practice Address - Phone:870-552-7837
Practice Address - Fax:870-552-7419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
ARAR203353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992889OtherPK
AR100365407Medicaid
0873470001Medicare NSC
0402026OtherNCPDP