Provider Demographics
NPI:1356450100
Name:RAGAN REXALL DRUG
Entity Type:Organization
Organization Name:RAGAN REXALL DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:R
Authorized Official - Middle Name:NORRIS
Authorized Official - Last Name:RAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:B S PHARMACY
Authorized Official - Phone:870-673-2741
Mailing Address - Street 1:309 S MAIN
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-4356
Mailing Address - Country:US
Mailing Address - Phone:870-673-2741
Mailing Address - Fax:870-673-3016
Practice Address - Street 1:309 S MAIN
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-4356
Practice Address - Country:US
Practice Address - Phone:870-673-2741
Practice Address - Fax:870-673-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL0239156FX1800X
ARPD05278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0406288OtherNABP
AR4141970001Medicare ID - Type Unspecified