Provider Demographics
NPI:1598808859
Name:HOUSTON, DICKERSON, AND DICKERSON
Entity Type:Organization
Organization Name:HOUSTON, DICKERSON, AND DICKERSON
Other - Org Name:HARVEST FOODS PHARMACY #3140
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-705-8906
Mailing Address - Street 1:PO BOX 1336
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-1336
Mailing Address - Country:US
Mailing Address - Phone:479-705-8407
Mailing Address - Fax:479-705-1027
Practice Address - Street 1:502 S CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4006
Practice Address - Country:US
Practice Address - Phone:479-705-8407
Practice Address - Fax:479-705-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR202103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0420935OtherNABP OR NCPDP
ARAR20210OtherPHARMACY LICENSE NUMBER
AR139366407Medicaid
ARBH6685145OtherDEA NUMBER