Provider Demographics
NPI:1932150448
Name:COUNTY DISCOUNT PHARMACY INC
Entity Type:Organization
Organization Name:COUNTY DISCOUNT PHARMACY INC
Other - Org Name:COUNTY DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:479-969-6022
Mailing Address - Street 1:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:MAGAZINE
Mailing Address - State:AR
Mailing Address - Zip Code:72943-0377
Mailing Address - Country:US
Mailing Address - Phone:479-969-2727
Mailing Address - Fax:479-969-2050
Practice Address - Street 1:48 S GARLAND ST
Practice Address - Street 2:
Practice Address - City:MAGAZINE
Practice Address - State:AR
Practice Address - Zip Code:72943-8996
Practice Address - Country:US
Practice Address - Phone:479-969-2727
Practice Address - Fax:479-969-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
ARAR205293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160371407Medicaid
1989609OtherPK