Organization
PATS SUPER V DRUG STORE INC
Active
Organization
PATS SUPER V DRUG STORE INC
Active
Other names
SUPER V DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY REED PD (OWNER PHCST)
(870) 972-6470
Entity
Organization
Contact information
Practice address
1000 E MATTHEWS AVE, STE A, JONESBORO, AR 72401-4307
(870) 972-6470
(870) 972-0710
Mailing address
1000 E MATTHEWS AVE, STE A, JONESBORO, AR 72401-4307
(870) 972-6470
(870) 972-0710
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR10821
AR
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121246407
—
AR
05
—
128304716
—
AR
01
—
1994112
PK
—
Enumeration date
08/02/2006
Last updated
09/28/2016
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