Organization
PORTLAND DRUG INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STANTON ETHERIDGE VEAZEY BS PHARMACY (PRESIDENT)
(870) 737-2813
Entity
Organization
Contact information
Practice address
105 HWY 165 SOUTH, PORTLAND, AR 71663
(870) 737-2813
Mailing address
PO BOX 246, PORTLAND, AR 71663-0246
(870) 737-2813
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0411429
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0411429
NABP
AR
Enumeration date
05/17/2007
Last updated
08/22/2020
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