DELTA DRUG OF DERMOTT, INC (NPI# 1427191154) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427191154 |
| Entity Type | Organization |
| Organization Name | DELTA DRUG OF DERMOTT, INC |
| Practice Address |
111 E Peddicord St Dermott AR 71638-2314 |
| Mailing Address |
Po Box 348 Dermott AR 71638-0348 |
| Practice Telephone | 8705385510 |
| Practice Fax Number | 8705385717 |
| Mailing Telephone | 8705385510 |
| Mailing Fax Number | 8705385717 |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2020-02-07 |
| Authorized Official Name | DR. KHALIL LYNN CROUSE (PRESIDENT) |
| Authorized Official Telephone | 8705385510 |
| Authorized Official Credential | PHARMD, FAARM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers | ||
| Y | 333600000X | Pharmacy | 65032 | AR | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 100262407 | 05 |
| Street Address |
111 E PEDDICORD ST |
| City | DERMOTT |
| State | AR |
| Zip Code | 71638-2314 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770191520 | Case Henderson | Pharmacist | 111 E Peddicord St, Dermott, AR 71638-2348 | 2020-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104251180 | Rebekah Ayecock | Nurse Practitioner | 300 South School St, Dermott, AR 71638 | 2013-09-09 |
| 1508198201 | Roger Alan Mason | Surgery | 300 South School St., Dermott, AR 71638 | 2010-02-04 |
| 1730219353 | Dermott Day Service Center, Inc. | Day Training, Developmentally Disabled Services | 817 North School Street, Dermott, AR 71638 | 2007-03-06 |
| 1134286750 | Dermott City Nursing Home | Skilled Nursing Facility | 702 West Gaines St., Dermott, AR 71638 | 2007-01-02 |
| 1861555005 | Dermott High School | Local Education Agency (LEA) | 525 East Speedway, Dermott, AR 71638 | 2006-12-19 |
| 1811095656 | Phillip W Pennington | Dentist | 300 S School, Dermott, AR 71638 | 2006-09-20 |
| 1669401501 | Mainline Health Systems, Inc | Clinic/Center | 134 South Strickland St, Dermott, AR 71638 | 2006-07-02 |
| 1982643409 | Jeffery Fenton Dunn Sr. | Pharmacist | 111 E Peddicord Street, Dermott, AR 71638 | 2006-06-06 |
| 1609298306 | Cb King Jm | Day Training, Developmentally Disabled Services | 1109 North School, Dermott, AR 71638-0000 | 2014-01-15 |
| 1780119610 | Medical Transport Management, Inc | Ambulance | 109 W Peddicord St, Dermott, AR 71638-2115 | 2017-04-28 |
| Find all providers in zip 71638 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| 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. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629083217 | Professional Pharmacy Services Inc | Pharmacy | 103 S Freeman St, Dermott, AR 71638-2306 | 2006-07-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679198212 | Rachel Hardke | Pharmacy | 14984 Highway 86 W, Hazen, AR 72064-8348 | 2020-06-09 |
| 1821612326 | Sheridan Family Pharmacy LLC | Pharmacy | 677 Heritage Drive, Sheridan, AR 72150-5000 | 2020-06-01 |
| 1235614421 | Greenbrier Pharmacy Inc | Pharmacy | 61a South Broadview St, Greenbrier, AR 72058 | 2018-10-03 |
| 1376048124 | Bono Family Pharmacy, LLC | Pharmacy | 10040 Highway 63 S Ste 4, Bono, AR 72416-8669 | 2018-03-26 |
| 1073014866 | East End Express Pharmacy Inc | Pharmacy | 21019 Highway 167, Suite 100, Hensley, AR 72065 | 2018-02-27 |
| 1326546524 | White River Pharmacy, LLC | Pharmacy | 7321 W Sunset Ave Ste G, Springdale, AR 72762-0990 | 2018-01-23 |
| 1013422179 | Ppg Store 6 LLC | Pharmacy | 2235 Dave Ward Dr Ste 108, Conway, AR 72034-7040 | 2017-12-11 |
| 1952814857 | Health-wise Pharmacy Pllc | Pharmacy | 47 S Hwy 71 Bypass, Waldron, AR 72958 | 2017-11-14 |
| 1598278806 | Genoa Healthcare, LLC | Pharmacy | 21 Bridgeway Rd Ste P, North Little Rock, AR 72113-9514 | 2017-11-08 |
| 1811414972 | Genoa Healthcare, LLC | Pharmacy | 715 N College Ave Ste P1, El Dorado, AR 71730-4403 | 2017-08-29 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on DELTA DRUG OF DERMOTT, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.