Organization
MAINLINE PHARMACY SERVICES INC
Active
Other names
Clinic Pharmacy of Monticello
Organization subpart
No
Provider details
NPI number
Authorized official
KHALIL L CROUSE (PRESIDENT)
(870) 265-6604
Entity
Organization
Contact information
Practice address
535 JORDAN DR STE B, MONTICELLO, AR 71655-5714
(870) 224-0650
(870) 224-0652
Mailing address
PO BOX 552, LAKE VILLAGE, AR 71653-0552
(870) 265-2220
(870) 265-3538
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
07/14/2021
Last updated
09/13/2021
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