Provider Demographics
NPI:1538273503
Name:CLINIC DRUG OF SEARCY INC
Entity type:Organization
Organization Name:CLINIC DRUG OF SEARCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PIC
Authorized Official - Prefix:
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:501-268-5811
Mailing Address - Street 1:1120 S MAIN ST
Mailing Address - Street 2:STE B
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143
Mailing Address - Country:US
Mailing Address - Phone:501-268-5811
Mailing Address - Fax:501-305-4316
Practice Address - Street 1:1120 S MAIN ST
Practice Address - Street 2:STE B
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143
Practice Address - Country:US
Practice Address - Phone:501-268-5811
Practice Address - Fax:501-305-4316
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINIC DRUG OF SEARCY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR203793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0406757OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AR152228407Medicaid