Provider Demographics
NPI:1376647594
Name:ROSE DRUG OF DOVER, INC
Entity Type:Organization
Organization Name:ROSE DRUG OF DOVER, INC
Other - Org Name:BERRY DRUG OF DARDANELLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:479-229-4811
Mailing Address - Street 1:417 UNION ST
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-3429
Mailing Address - Country:US
Mailing Address - Phone:479-229-4811
Mailing Address - Fax:479-229-5871
Practice Address - Street 1:417 UNION ST
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-3429
Practice Address - Country:US
Practice Address - Phone:479-229-4811
Practice Address - Fax:479-229-5871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR20230332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148363716Medicaid
AR4491640001Medicare NSC