Organization
PORTLAND DRUG LLC
Active
Other names
Portland Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHALIL LYNN CROUSE (OWNER/PHARMACIST)
(870) 265-2220
Entity
Organization
Contact information
Practice address
233 N MAIN ST STE B, PORTLAND, AR 71663-9230
(870) 737-2813
(870) 737-2781
Mailing address
PO BOX 552, LAKE VILLAGE, AR 71653-0552
(870) 265-2220
(870) 265-3538
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
AR11429
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204989407
—
AR
Enumeration date
05/16/2014
Last updated
05/06/2026
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