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DELTA DRUG OF DERMOTT INC NPI 1427191154


NPI Information

NPI: 1427191154
Provider Name: DELTA DRUG OF DERMOTT, INC
Classification: Pharmacy - 333600000X
Entity Type: Organization

CLIA Number: 04D2188886

Address:
111 E PEDDICORD ST
DERMOTT, AR
ZIP 71638
Phone: (870) 538-5510
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DELTA DRUG OF DERMOTT, INC is a pharmacy in Dermott, AR. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. DELTA DRUG OF DERMOTT, INC NPI is 1427191154. The provider is registered as an organization entity type.

The provider's business location address is:

111 E PEDDICORD ST
DERMOTT, AR
ZIP 71638-314
Phone: (870) 538-5510
Fax: (870) 538-5717

The provider's authorized official is Khalil Lynn Crouse .
The authorized official title is President and has the following contact phone number (870) 538-5510.

The CLIA number assigned to this NPI record is 04D2188886 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/14/2007 and was last updated on 2/7/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1333600000XPharmacy65032ARKANSASYes
23336L0003XPharmacyLong Term Care PharmacyNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1100262407MEDICAIDARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.