Organization
DELTA DRUG OF DERMOTT, INC
Active
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 552, LAKE VILLAGE, AR 71653-0552
(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
06/11/2026
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