Provider Demographics
NPI:1811983406
Name:CITY DRUG CO
Entity type:Organization
Organization Name:CITY DRUG CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DODD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:870-236-8501
Mailing Address - Street 1:1512 LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5814
Mailing Address - Country:US
Mailing Address - Phone:870-236-8501
Mailing Address - Fax:870-239-5324
Practice Address - Street 1:1512 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5814
Practice Address - Country:US
Practice Address - Phone:870-236-8501
Practice Address - Fax:870-239-5324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
ARAR07014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0407014OtherNCPDP
MO607690500Medicaid
AR100212407Medicaid