Provider Demographics
NPI:1376530659
Name:DRSRX, INC
Entity Type:Organization
Organization Name:DRSRX, INC
Other - Org Name:CLARK DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CURD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-724-3261
Mailing Address - Street 1:PO BOX 1130
Mailing Address - Street 2:2116 HWY 367N
Mailing Address - City:BALD KNOB
Mailing Address - State:AR
Mailing Address - Zip Code:72010-1130
Mailing Address - Country:US
Mailing Address - Phone:501-724-3261
Mailing Address - Fax:501-724-6507
Practice Address - Street 1:2116 HIGHWAY 367 N
Practice Address - Street 2:
Practice Address - City:BALD KNOB
Practice Address - State:AR
Practice Address - Zip Code:72010-9443
Practice Address - Country:US
Practice Address - Phone:501-724-3261
Practice Address - Fax:501-724-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR8165183500000X
332B00000X
ARAR203773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR156437716Medicaid
AR152539407Medicaid
AR156437716Medicaid