Provider Demographics
NPI:1730940487
Name:COLEMAN PHARMACY OF CRAWFORD COUNTY INC.
Entity type:Organization
Organization Name:COLEMAN PHARMACY OF CRAWFORD COUNTY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:479-262-2156
Mailing Address - Street 1:PO BOX 2550
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-2550
Mailing Address - Country:US
Mailing Address - Phone:479-262-2156
Mailing Address - Fax:479-262-2264
Practice Address - Street 1:110 FAYETTEVILLE AVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-3654
Practice Address - Country:US
Practice Address - Phone:479-262-2156
Practice Address - Fax:479-262-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy