Organization
CITY DRUG OF MONTICELLO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KHALIL LYNN CROUSE PHARM.D. (OWNER)
(870) 265-2220
Entity
Organization
Contact information
Practice address
201 E GAINES ST, MONTICELLO, AR 71655-4903
(870) 367-5301
(870) 460-0257
Mailing address
201 E GAINES ST, MONTICELLO, AR 71655-4903
(870) 367-5301
(870) 460-0257
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111058416
—
AR
Enumeration date
02/15/2007
Last updated
05/27/2011
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