Provider Demographics
NPI:1346580420
Name:C. A. KUYKENDALL, INC
Entity Type:Organization
Organization Name:C. A. KUYKENDALL, INC
Other - Org Name:VILLAGE HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:KUYKENDALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:PD
Authorized Official - Phone:479-667-2101
Mailing Address - Street 1:500 W COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949-3112
Mailing Address - Country:US
Mailing Address - Phone:479-667-2101
Mailing Address - Fax:479-667-1270
Practice Address - Street 1:500 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949-3112
Practice Address - Country:US
Practice Address - Phone:479-667-2101
Practice Address - Fax:479-667-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR12813333600000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR10678OtherPTAN NOVITAS
AR100486407Medicaid
AR100486407Medicaid