Organization
SMITHS COUNTRY CLUB DRUG STORE INC
Active
Other names
SMITHS COUNTRY CLUB DRUG STORE INC
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA INGELS (PRESIDENT)
(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
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR19211
AR
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160237407
—
AR
01
—
1988096
PK
—
Enumeration date
02/06/2007
Last updated
06/13/2016
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