Provider Demographics
NPI:1932274362
Name:BIG WORLD DRUG ENTERPRISES INC
Entity Type:Organization
Organization Name:BIG WORLD DRUG ENTERPRISES INC
Other - Org Name:MEDI-QUIK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:GEDDES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:479-675-3900
Mailing Address - Street 1:1531 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927
Mailing Address - Country:US
Mailing Address - Phone:479-675-3900
Mailing Address - Fax:479-675-5909
Practice Address - Street 1:1531 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927
Practice Address - Country:US
Practice Address - Phone:479-675-3900
Practice Address - Fax:479-675-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD05465333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR164410716Medicaid
ARAB6449854OtherDEA #
ARAB6449854OtherDEA #
AR164410716Medicaid