Provider Demographics
NPI:1821003435
Name:COTTON & EARLS DRUG STORES INC
Entity Type:Organization
Organization Name:COTTON & EARLS DRUG STORES INC
Other - Org Name:WEINER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-684-2214
Mailing Address - Street 1:212 N VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:WEINER
Mailing Address - State:AR
Mailing Address - Zip Code:72479-8948
Mailing Address - Country:US
Mailing Address - Phone:870-684-2214
Mailing Address - Fax:870-684-7576
Practice Address - Street 1:212 N VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:WEINER
Practice Address - State:AR
Practice Address - Zip Code:72479-8948
Practice Address - Country:US
Practice Address - Phone:870-684-2214
Practice Address - Fax:870-684-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR155423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR113753407Medicaid
1994865OtherPK
AR113753407Medicaid