Organization
EUDORA PHARMACY INC
Active
Other names
EUDORA DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
KHALIL CROUSE RPH (OWNER)
(870) 355-4448
Entity
Organization
Contact information
Practice address
200 S MAIN ST, EUDORA, AR 71640-3061
(870) 355-4448
(870) 355-2444
Mailing address
PO BOX 552, LAKE VILLAGE, AR 71653-0552
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
AR19689
AR
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160503407
—
AR
01
—
1992912
PK
—
Enumeration date
07/30/2006
Last updated
03/15/2022
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