Provider Demographics
NPI:1649280389
Name:RECTOR DOWNTOWN DRUG, INC.
Entity type:Organization
Organization Name:RECTOR DOWNTOWN DRUG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-595-3523
Mailing Address - Street 1:403 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RECTOR
Mailing Address - State:AR
Mailing Address - Zip Code:72461-1706
Mailing Address - Country:US
Mailing Address - Phone:870-595-3523
Mailing Address - Fax:
Practice Address - Street 1:403 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RECTOR
Practice Address - State:AR
Practice Address - Zip Code:72461-1706
Practice Address - Country:US
Practice Address - Phone:870-595-3523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO183500000X, 332B00000X
AR332B00000X, 183500000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR115515407Medicaid
MO623892007Medicaid
MO603892001Medicaid