Provider Demographics
NPI:1659756104
Name:CBC SPRINGDALE LLC
Entity type:Organization
Organization Name:CBC SPRINGDALE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-814-0605
Mailing Address - Street 1:701 S THOMPSON ST STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4201
Mailing Address - Country:US
Mailing Address - Phone:479-751-2072
Mailing Address - Fax:479-751-2341
Practice Address - Street 1:701 S THOMPSON ST STE A
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4201
Practice Address - Country:US
Practice Address - Phone:479-751-2072
Practice Address - Fax:479-751-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR200463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153448OtherPK