Provider Demographics
NPI:1770676918
Name:SMITH CALDWELL DRUG
Entity Type:Organization
Organization Name:SMITH CALDWELL DRUG
Other - Org Name:SMITH CALDWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:TONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-315-7700
Mailing Address - Street 1:414 N MAIN ST
Mailing Address - Street 2:PO BOX 663
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015
Mailing Address - Country:US
Mailing Address - Phone:501-315-7700
Mailing Address - Fax:501-315-0077
Practice Address - Street 1:414 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015
Practice Address - Country:US
Practice Address - Phone:501-315-7700
Practice Address - Fax:501-315-4136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336C0004X, 3336L0003X, 3336S0011X, 3336S0011X
ARAR194513336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100106407Medicaid
1988118OtherPK
1988118OtherPK