Provider Demographics
NPI:1619711256
Name:DRUG STORE INC
Entity type:Organization
Organization Name:DRUG STORE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDD
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:501-223-2636
Mailing Address - Street 1:11121 N RODNEY PARHAM RD STE 42B
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4108
Mailing Address - Country:US
Mailing Address - Phone:501-223-2636
Mailing Address - Fax:501-224-5253
Practice Address - Street 1:11121 N RODNEY PARHAM RD STE 42B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4108
Practice Address - Country:US
Practice Address - Phone:501-223-2636
Practice Address - Fax:501-224-5253
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRUG STORE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-19
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy