Provider Demographics
NPI:1497458988
Name:COLLIER DRUG STORES, INC.
Entity Type:Organization
Organization Name:COLLIER DRUG STORES, INC.
Other - Org Name:COLLIER DRUG CAVE SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:479-442-6262
Mailing Address - Street 1:PO BOX 1085
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1085
Mailing Address - Country:US
Mailing Address - Phone:479-935-4345
Mailing Address - Fax:
Practice Address - Street 1:260 S GLENEAGLE DR
Practice Address - Street 2:
Practice Address - City:CAVE SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72718-6011
Practice Address - Country:US
Practice Address - Phone:479-203-7014
Practice Address - Fax:833-702-2079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy