Provider Demographics
NPI:1568569309
Name:BARRETT RX INC
Entity Type:Organization
Organization Name:BARRETT RX INC
Other - Org Name:DUSTY'S GREEN FOREST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUSTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:479-559-2183
Mailing Address - Street 1:PO BOX 1299
Mailing Address - Street 2:
Mailing Address - City:GREEN FOREST
Mailing Address - State:AR
Mailing Address - Zip Code:72638-1299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:309 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GREEN FOREST
Practice Address - State:AR
Practice Address - Zip Code:72638-2432
Practice Address - Country:US
Practice Address - Phone:870-438-5614
Practice Address - Fax:870-438-6256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR203983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0415352OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AR141449407Medicaid
5579960001Medicare NSC