Provider Demographics
NPI:1689781213
Name:CLONTZ ENTERPRISES INC
Entity Type:Organization
Organization Name:CLONTZ ENTERPRISES INC
Other - Org Name:DALES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:870-247-4411
Mailing Address - Street 1:5411 DOLLARWAY RD
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71602-3907
Mailing Address - Country:US
Mailing Address - Phone:870-247-4411
Mailing Address - Fax:870-247-3207
Practice Address - Street 1:5411 DOLLARWAY RD
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71602-3907
Practice Address - Country:US
Practice Address - Phone:870-247-4411
Practice Address - Fax:870-247-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
AR0076743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0417611OtherNABP
ARBD3199759OtherDEA
AR0417611OtherNABP