Organization
BOBBY TEETERS DRUG STORE INC
Active
Other names
BOBBY TEETERS DRUG STORE INC
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT TEETER PD (OWNER PIC)
(479) 754-2196
Entity
Organization
Contact information
Practice address
200 W MAIN ST, CLARKSVILLE, AR 72830-3010
(479) 754-2196
(479) 754-8885
Mailing address
200 W MAIN ST, CLARKSVILLE, AR 72830-3010
(479) 754-2196
(479) 754-8885
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR11847
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0411847
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
100098407
—
AR
Enumeration date
10/03/2006
Last updated
07/18/2011
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