Provider Demographics
NPI:1033102769
Name:CITY PHARMACY OF RISON
Entity type:Organization
Organization Name:CITY PHARMACY OF RISON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ROTH
Authorized Official - Middle Name:
Authorized Official - Last Name:RABB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-325-6237
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:RISON
Mailing Address - State:AR
Mailing Address - Zip Code:71665-0387
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 MAIN ST
Practice Address - Street 2:
Practice Address - City:RISON
Practice Address - State:AR
Practice Address - Zip Code:71665
Practice Address - Country:US
Practice Address - Phone:870-325-6237
Practice Address - Fax:870-325-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR05832333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0405832OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4483510001Medicare ID - Type Unspecified