# DAVY CROCKETT DRUG, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Davy Crockett Drug (LTC)
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649752163
- **Authorized official:** JAMES JEFFREY MARTIN RPH (PRESIDENT)
- **Authorized official phone:** (936) 544-2275

## Contact information

- **Practice address:** 107 S 4TH ST, CROCKETT, TX 75835-2024
- **Practice address phone:** (936) 544-2275
- **Practice address fax:** (936) 206-7696
- **Mailing address:** 107 S 4TH ST, CROCKETT, TX 75835-2024
- **Mailing address phone:** (936) 544-2275
- **Mailing address fax:** (936) 206-7696

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 04623 | TX | Yes |

## Other

- **Enumeration date:** 08/31/2018
- **Last updated:** 09/05/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 141598 | — | TX |