Organization
SMITHS COUNTRY CLUB DRUG STORE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA ANN INGELS (BILLING AGENT)
(501) 663-4118
Entity
Organization
Contact information
Practice address
5114 KAVANAUGH BLVD, LITTLE ROCK, AR 72207-4607
(501) 663-4118
(501) 663-4110
Mailing address
5114 KAVANAUGH BLVD, LITTLE ROCK, AR 72207-4607
(501) 663-4118
(501) 663-4110
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0419211
—
IL
Enumeration date
11/09/2005
Last updated
09/02/2011
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