Provider Demographics
NPI:1457362030
Name:ROSE DRUG PARIS INC
Entity Type:Organization
Organization Name:ROSE DRUG PARIS INC
Other - Org Name:ROSE DRUG OF PARIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-963-6400
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:AR
Mailing Address - Zip Code:72855-0648
Mailing Address - Country:US
Mailing Address - Phone:479-963-6400
Mailing Address - Fax:479-963-2103
Practice Address - Street 1:1211 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:AR
Practice Address - Zip Code:72855-4125
Practice Address - Country:US
Practice Address - Phone:479-963-6400
Practice Address - Fax:479-963-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR131703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0413170OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AR10085940Medicaid