Organization
DELTA DRUG OF DERMOTT, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHALIL LYNN CROUSE PHARMD, FAARM (PRESIDENT)
(870) 538-5510
Entity
Organization
Contact information
Practice address
111 E PEDDICORD ST, DERMOTT, AR 71638-2314
(870) 538-5510
(870) 538-5717
Mailing address
PO BOX 348, DERMOTT, AR 71638-0348
(870) 538-5510
(870) 538-5717
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
65032
AR
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100262407
—
AR
Enumeration date
02/14/2007
Last updated
09/29/2025
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